Coronary artery bypass grafting bundled payment proposal will have significant financial impact on hospitals
Coronary artery bypass grafting bundled payment proposal will have significant financial impact on hospitals
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DOI：
10.1016/j.jtcvs.2017.07.035
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发表时间：
2018-01-01
影响因子：
6
通讯作者：
Ailawadi, Gorav
中科院分区：
文献类型：
--
作者：
Hawkins, Robert B.;Mehaffey, J. Hunter;Ailawadi, Gorav
目的：医疗保险和医疗补助服务中心计划在出院后90天内对冠状动脉旁路移植术进行为期5年的捆绑支付试验。为了调查其影响，我们回顾了接受搭桥手术的患者的实际住院费用相对于目标price.Methods：共有13,276名医疗保险患者的估计成本数据进行了隔离冠状动脉搭桥术，从2008年至2015年在18家医院超过8个医疗保险定义的地区在弗吉尼亚州联邦。实际2015年住院费用进行了比较，估计的目标价格为每年的试点，根据前3年和分层的诊断相关Group.Results：平均2015年成本每名患者为50,394美元，变异大（范围，27,862美元-74,169美元）。平均而言，医院在第一年将收到17，682美元的退款，但在第五年，医疗保险的欠款将增加到367，985美元。如果2015年是试点的最后一年，18家医院中有13家（72%）将欠医疗保险平均614，270美元（范围67，404美元-2，102，292美元）的成本超支。18家医院中有5家的成本低于目标价格，医疗保险和医疗补助服务中心平均将向他们支付额外的272，355美元（范围为88，628美元至567，429美元）。结论：由于平均每年3.6%的成本增长和支付的自动减少，医院将面临直接的财务压力。随着区域定价的逐步实施，医院可以预期欠医疗保险的金额会越来越多。净效应是将财务风险转移到医院，这可能会限制高风险患者获得护理。
Objectives: The Centers for Medicare and Medicaid Services plans to institute a 5-year trial of bundled payments for coronary artery bypass grafting through 90 days after discharge. To investigate the impact, we reviewed actual inpatient costs for patients undergoing bypass surgery relative to the target price.Methods: A total of 13,276 Medicare patients with estimated cost data underwent isolated coronary artery bypass grafting from 2008 to 2015 in 18 hospitals over 8 Medicare-defined regions within the Commonwealth of Virginia. Actual 2015 inpatient costs were compared with estimated target prices for each year of the pilot, based on the previous 3 years and stratified by Diagnosis-Related Group.Results: The mean 2015 cost per patient was $50,394 with high variation (range, $27,862-$74,169). On average, hospitals would receive a refund of $17,682 in year 1, but then owe Medicare increasing amounts up to $367,985 in year 5. If 2015 were the final year of the pilot, 13 of the 18 hospitals (72%) would have owed Medicare for cost overruns averaging $614,270 (range, $67,404-$2,102,292). Costs were below the target price at 5 of 18 hospitals, and the Centers for Medicare and Medicaid Services would have paid them an extra $272,355 on average (range, $88,628-$567,429).Conclusions: Hospitals will face immediate financial pressure due to average cost increases of 3.6% per year and an automatic reduction in payment. As regional pricing is phased in, hospitals can expect to owe Medicare increasing amounts. The net effect is shifting of financial risks to hospitals, which could restrict access to care for higher-risk patients.