Large variations in Medicare payments for surgery highlight savings potential from bundled payment programs.
Large variations in Medicare payments for surgery highlight savings potential from bundled payment programs.
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DOI：
10.1377/hlthaff.2011.0783
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发表时间：
2011-11
期刊：
影响因子：
--
通讯作者：
Birkmeyer JD
中科院分区：
文献类型：
--
作者：
Miller DC;Gust C;Dimick JB;Birkmeyer N;Skinner J;Birkmeyer JD
付款人正在考虑对住院手术进行捆绑付款，将提供者的报销合并为整个事件的一次性付款。我们发现，目前针对某些住院治疗的 Medicare 事件付款在分为 5 个付款组的医院之间存在 49-130% 的差异。由于地理位置或疾病严重程度等因素造成的付款故意差异在很大程度上解释了这种差异。但在调整这些差异后，成本最高的医院每期支付的费用比成本最低的医院支付的费用高出高达 2,549 美元的结肠切除术和 7,759 美元的背部手术。出院后护理在支付差异中占很大比例，全权医生服务也是如此，这可能是由外科医生执业风格的差异驱动的。我们的研究表明，捆绑支付可以为付款人节省大量费用，尽管对各个机构的影响会有所不同，因为某项手术相对昂贵的医院通常对其他手术相对便宜。更广泛地说，我们的数据表明，许多医院有相当大的空间来提高住院手术的成本效率，并且应该寻找过度利用的模式，特别是在外科专科、其他住院专科咨询和各种类型的出院后护理中。
Payers are considering bundled payments for inpatient surgery, combining provider reimbursements into a single payment for the entire episode. We found that current Medicare episode payments for certain inpatient procedures varied by 49–130 percent across hospitals sorted into five payment groups. Intentional differences in payments attributable to such factors as geography or illness severity explained much of this variation. But after adjustment for these differences, per episode payments to the highest-cost hospitals were higher than those to the lowest-cost facilities by up to $2,549 for colectomy and $7,759 for back surgery. Postdischarge care accounted for a large proportion of the variation in payments, as did discretionary physician services, which may be driven in turn by variations in surgeons’ practice styles. Our study suggests that bundled payments could yield sizable savings for payers, although the effect on individual institutions will vary because hospitals that were relatively expensive for one procedure were often relatively inexpensive for others. More broadly, our data suggest that many hospitals have considerable room to improve their cost efficiency for inpatient surgery and should look for patterns of excess utilization, particularly among surgical specialties, other inpatient specialist consultations, and various types of postdischarge care.
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影响因子：
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影响因子：
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