An administrative claims measure of payments made for Medicare patients for a 30-day episode of care for acute myocardial infarction.
An administrative claims measure of payments made for Medicare patients for a 30-day episode of care for acute myocardial infarction.
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一项行政索赔措施，用于衡量 Medicare 患者因急性心肌梗塞而接受 30 天的护理所支付的费用。
DOI：
10.1097/mlr.0000000000000361
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发表时间：
2015
期刊：
影响因子：
3
通讯作者：
Krumholz,HarlanM
中科院分区：
文献类型：
--
作者：
Kim,Nancy;Bernheim,SusannahM;Ott,LesliS;Han,Lein;Spivack,StevenB;Xu,Xiao;Volpe,Mark;Liu,Alex;Krumholz,HarlanM
背景：了解各机构的成本和质量是阐明医疗保险购买的护理价值的关键第一步。根据与医疗保险和医疗补助服务中心的合同，我们开发了一种方法，通过30天的护理成本（支付医疗保险受益人）急性心肌梗死（AMI）的医院概况：方法：我们开发了一个分层广义线性回归模型，以计算30天的AMI发作的医院风险标准化支付（RSP）。使用2008年医疗保险索赔，我们确定了65岁或以上患者的住院治疗，出院诊断为ICD-9代码410。xx.我们将AMI事件定义为入院日期加30天。为了反映临床护理，我们忽略或平均了地理因素和政策举措的支付调整。我们对AMI住院前12个月内确定的临床变量进行了风险调整。结合2008-2009年的数据，我们评估措施的可靠性，使用组内相关系数和计算最终RSP.Results：最终模型包括30个变量，并导致预测比率（平均预测支付/平均总支付）接近1。组内相关系数为0.79。在2382家住院≥ 25次的医院中，未调整的平均支付额为20，324美元，范围从11，089美元到41，897美元。平均RSP为21，125美元，范围从13，909美元到28，979美元。结论：本研究介绍了一个基于索赔的RSP测量AMI 30天护理事件。不同医院的RSP各不相同，付款范围为2倍。当与质量措施相结合时，这种支付措施将有助于介绍高价值的护理。
Background:Understanding both cost and quality across institutions is a critical first step to illuminating the value of care purchased by Medicare. Under contract with the Centers for Medicare and Medicaid Services, we developed a method for profiling hospitals by 30-day episode-of-care costs (payments for Medicare beneficiaries) for acute myocardial infarction (AMI).Methods:We developed a hierarchical generalized linear regression model to calculate hospital risk-standardized payment (RSP) for a 30-day episode for AMI. Using 2008 Medicare claims, we identified hospitalizations for patients 65 years of age or older with a discharge diagnosis of ICD-9 codes 410. xx. We defined an AMI episode as the date of admission plus 30 days. To reflect clinical care, we omitted or averaged payment adjustments for geographic factors and policy initiatives. We risk-adjusted for clinical variables identified in the 12 months preceding and including the AMI hospitalization. Using combined 2008–2009 data, we assessed measure reliability using an intraclass correlation coefficient and calculated the final RSP.Results:The final model included 30 variables and resulted in predictive ratios (average predicted payment/average total payment) close to 1. The intraclass correlation coefficient score was 0.79. Across 2382 hospitals with≥ 25 hospitalizations, the unadjusted mean payment was $20,324 ranging from $11,089 to $41,897. The mean RSP was $21,125 ranging from $13,909 to $28,979.Conclusions:This study introduces a claims-based measure of RSP for an AMI 30-day episode of care. The RSP varies among hospitals, with a 2-fold range in payments. When combined with quality measures, this payment measure will help profile high-value care.