Medical oncologists' willingness to participate in bundled payment programs.
Medical oncologists' willingness to participate in bundled payment programs.
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DOI：
10.1186/s12913-018-3202-y
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发表时间：
2018-05-31
影响因子：
2.8
通讯作者：
Armstrong K
中科院分区：
文献类型：
--
作者：
Murciano-Goroff YR;McCarthy AM;Bristol MN;Domchek SM;Groeneveld PW;Motanya UN;Armstrong K
捆绑支付计划在改变肿瘤治疗报销方式方面发挥着越来越重要的作用。我们评估了肿瘤学家是否愿意参与乳腺癌捆绑支付计划的决定因素。我们假设，如果为每一期护理提供更高的报销水平，提供者将更有可能参与捆绑支付计划。来自佛罗里达州、新泽西州、纽约州和宾夕法尼亚州的肿瘤学家在AMA数据库中或由州癌症登记中列出的患者识别。提供者被随机分为四个版本，其中一个版本描述了捆绑支付计划，该计划为乳腺癌局部治疗的第一年提供不同水平的补偿(5000美元、1万美元、1.5万美元或2万美元)。医生们对他们参与捆绑项目的可能性进行了利克特评分。使用Logistic回归分析参与捆绑销售可能性的决定因素。在460名受访者中，只有17%的肿瘤学家非常有可能参加第一年支付5000美元的捆绑计划，其中1.5万美元的计划上升到41%，而2万美元的计划下降到34%。在男性、年长的肿瘤学家中，参与的可能性更高，他们认为不应该向癌症患者提供高成本的药物，而生存益处最小。我们的结果表明，医学肿瘤学家对捆绑付款的热情有限，更高的付款可能无法克服相当大比例的医生对捆绑付款的抵制。
Bundled payment programs play an increasingly important role in transforming reimbursement for oncologic care. We assessed determinants of oncologists’ willingness to participate in bundled payment programs for breast cancer. We hypothesized that providers would be more likely to participate in bundled payment programs if offered higher levels of reimbursement for each episode of care. Oncologists from Florida, New Jersey, New York, and Pennsylvania were identified in the AMA database or by patients listed in state cancer registries. Providers were randomized to receive one of four versions of a survey describing bundled payment programs offering different levels of compensation for the first year of localized breast cancer treatment ($5000, $10,000, $15,000, or $20,000). Physicians rated their likelihood of participation in a bundled program on a Likert scale. Logistic regression was used to analyze determinants of likelihood of participation in bundling. Among 460 respondents, only 17% of oncologists were highly likely to participate in a bundled program paying $5000 for the first year of care, rising to 41% for the $15,000 program, but falling to 34% for the $20,000 program. Likelihood of participation was higher among oncologists who were male, older, and believed that cancer patients should not be offered high-cost drugs with minimal survival benefit. Our results suggest that medical oncologists have limited enthusiasm for bundled payments, and higher payments may not overcome resistance to bundling among a substantial proportion of physicians.
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影响因子：
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