Medicare Payments for Common Inpatient Procedures: Implications for Episode-Based Payment Bundling
Medicare Payments for Common Inpatient Procedures: Implications for Episode-Based Payment Bundling
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DOI：
10.1111/j.1475-6773.2010.01150.x
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发表时间：
2010-12-01
影响因子：
3.4
通讯作者：
Skinner, Jonathan S.
中科院分区：
文献类型：
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作者：
Birkmeyer, John D.;Gust, Cathryn;Skinner, Jonathan S.
为了使提供者的激励措施与提高质量和效率相一致，医疗保险和医疗补助服务中心正在考虑围绕住院手术的事件更广泛地捆绑医院和医生的支付。关于捆绑支付的决定将受益于更好的信息，目前如何支付不同的围手术期服务的提供者之间的分配，以及如何支付不同hospital.Study设计使用国家医疗保险数据库，我们确定了在2005年进行四个住院手术（冠状动脉搭桥术[CABG]，髋部骨折修复，背部手术，结肠切除术）的患者之一。对于每一个程序，价格标准化的医疗保险支付从入院之日的索引程序出院后30天进行了评估和分类的支付类型（医院，医生，和急性期后护理）和亚型。26，515背部手术至美元冠状动脉旁路移植术45,358例。医院支付占总支付的最大份额（60- 80%，取决于程序），其次是医生支付（13- 19%）和急性后护理（7- 27%）。最低和最高支付四分位数的医院的总剧集支付金额相差美元CABG 16，668美元背部手术18，762美元10，615用于髋部骨折修复，以及美元结肠切除术12988对医院的付款在付款变化中占最大份额。在特定类型的付款，与30天的再入院和急性期后护理变化最大的跨hospital.ConclusionsFully捆绑支付住院手术事件将需要分散在许多不同类型的供应商。医院的总体和具体服务的支付差别很大，可能会因医院和医生提高质量和效率的激励措施而减少。
BackgroundAiming to align provider incentives toward improving quality and efficiency, the Center for Medicare and Medicaid Services is considering broader bundling of hospital and physician payments around episodes of inpatient surgery. Decisions about bundled payments would benefit from better information about how payments are currently distributed among providers of different perioperative services and how payments vary across hospitals.Study DesignUsing the national Medicare database, we identified patients undergoing one of four inpatient procedures in 2005 (coronary artery bypass [CABG], hip fracture repair, back surgery, and colectomy). For each procedure, price-standardized Medicare payments from the date of admission for the index procedure to 30 days postdischarge were assessed and categorized by payment type (hospital, physician, and postacute care) and subtype.ResultsAverage total payments for inpatient surgery episodes varied from U.S.$26,515 for back surgery to U.S.$45,358 for CABG. Hospital payments accounted for the largest share of total payments (60-80 percent, depending on procedure), followed by physician payments (13-19 percent) and postacute care (7-27 percent). Overall episode payments for hospitals in the lowest and highest payment quartiles differed by U.S.$16,668 for CABG, U.S.$18,762 for back surgery, U.S.$10,615 for hip fracture repair, and U.S.$12,988 for colectomy. Payments to hospitals accounted for the largest share of variation in payments. Among specific types of payments, those associated with 30-day readmissions and postacute care varied most substantially across hospitals.ConclusionsFully bundled payments for inpatient surgical episodes would need to be dispersed among many different types of providers. Hospital payments-both overall and for specific services-vary considerably and might be reduced by incentives for hospitals and physicians to improve quality and efficiency.