How Does the Effect of the Comprehensive Care for Joint Replacement Model Vary Based on Surgical Volume and Costs of Care?
How Does the Effect of the Comprehensive Care for Joint Replacement Model Vary Based on Surgical Volume and Costs of Care?
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关节置换模型综合护理的效果如何根据手术量和护理费用而变化？
DOI：
10.1097/mlr.0000000000001785
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发表时间：
2023
期刊：
影响因子：
3
通讯作者：
Pelt,ChristopherE
中科院分区：
文献类型：
--
作者：
Ko,Hyunkyu;Martin,BrookI;Nelson,RichardE;Pelt,ChristopherE
背景：医疗保险和医疗补助创新中心（Center for Medicare and Medicaid Innovation）于2017年12月修订了全面的关节置换护理（CJR）计划，该计划是下肢关节置换术的强制性90天捆绑支付，保留了最初67个大都市统计区中的34个，这些大都市统计区具有更高的数量和历史事件支付。目的：我们描述了在CJR实施前后，继续参与CJR的医院与退出CJR的医院之间在成本、质量和患者选择方面的差异。研究设计：我们使用了三重差异方法来比较在CJR修订中保留或不保留的医院之间的择期入院政策影响的大小，研究对象：2013年1月1日至2017年8月31日期间接受选择性下肢关节置换术的694，275名医疗保险受益人。测量：CJR的治疗效果异质性。结果：与允许停止的医院相比，CJR政策修订中保留的医院90天护理期费用减少更大（− 846，95%CI：− 1，338，− 435），最近一年（2017年）的费用减少更大。我们还发现证据表明，保留CJR医院不成比例地减少治疗患者谁是年龄大于85 years.Conclusions：医院继续参与CJR后，政策修订实现了更大的成本降低。然而，成本的降低部分归因于避免潜在的高成本患者，这表明捆绑支付政策可能会导致医疗服务的差异。
Background:The Center for Medicare and Medicaid Innovation revised the comprehensive Care for Joint Replacement (CJR) program, a mandatory 90-day bundled payment for lower extremity joint replacement, in December 2017, retaining 34 of the original 67 metropolitan statistical areas with higher volume and historic episode payments.Objectives:We describe differences in costs, quality, and patient selection between hospitals that continued to participate compared with those that withdrew from CJR before and after the implementation of CJR.Research Design:We used a triple difference approach to compare the magnitude of the policy effect for elective admissions between hospitals that were retained in the CJR revision or not, before and after the implementation of CJR, and compared with hospitals in nonparticipant metropolitan statistical areas.Subjects:694,275 Medicare beneficiaries undergoing elective lower extremity joint replacement from January 1, 2013 to August 31, 2017Measures:The treatment effect heterogeneity of CJR.Results:Hospitals retained in the CJR policy revision had a greater reduction in 90-day episode-of-care cost compared with those that were allowed to discontinue (− $846, 95% CI:− $1,338,− $435) and had greater cost reductions in the more recent year (2017). We also found evidence that retained CJR hospitals disproportionately reduced treating patients who were older than 85 years.Conclusions:Hospitals that continued to participate in CJR after the policy revision achieved a greater cost reduction. However, the cost reductions were partly attributed to avoiding potential higher-cost patients, suggesting that a bundled payment policy might induce disparities in care delivery.
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DOI：
--
发表时间：
1977
期刊：
A M A Archives of Ophthalmology
影响因子：
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作者：
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DOI：
10.1042/bj1940299
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1981
期刊：
The Biochemical journal
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DOI：
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发表时间：
1957
期刊：
American journal of ophthalmology-glaucoma
影响因子：
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DOI：
--
发表时间：
1975
期刊：
影响因子：
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作者：
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K. Segawa