Can the Medicare Quality Payment Program Incentivize Evidence-Based Treatment of Depression and Anxiety Disorders by Primary Care Providers?

医疗保险质量支付计划能否激励初级保健提供者对抑郁症和焦虑症进行循证治疗？

• 批准号: 10366446
• 负责人: Kenton James Johnston
• 金额: $ 32.12万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-07 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10366446
• 关键词: Acute; Adopted; Anxiety Disorders; Area; Caring; Characteristics; Conflict (Psychology); Data; Data Set; Detection; Diagnosis; Disease; Disincentive; Event; Evidence based treatment; Expenditure; Financial Risk Sharing; Fostering; Health; Health Care Costs; Health Services Accessibility; Home; Incentives; Institutes; Link; Longitudinal Studies; Medical; Medical center; Medicare; Medicare claim; Mental Depression; Mental Health; Minority; Minority Groups; Mission; Modeling; National Institute of Mental Health; Organizational Models; Outcome; Outpatients; Patient Care; Patient-Focused Outcomes; Patients; Performance; Physicians; Poverty; Primary Health Care; Public Health; Research; Research Support; Risk; Risk Adjustment; Rural; Savings; Service delivery model; Services; Structure; Surveys; System; United States Centers for Medicare and Medicaid Services; acronyms; anxiety symptoms; base; behavioral health; beneficiary; care costs; care delivery; care providers; collaborative care; comorbidity; cost; cost outcomes; data centers; depressive symptoms; disability; ethnic minority population; evidence base; evidence based guidelines; experience; financial incentive; functional status; improved; incentive program; innovation; next generation; patient home care; patient oriented; patient population; payment; peer; primary care setting; programs; racial minority; risk selection; rural area; screening; screening guidelines; virtual

Project Summary Depression and anxiety disorders are common in patients in the primary care setting and have clear evidence- based guidelines for screening, diagnosis, and treatment. However, rates of screening and treatment among Medicare beneficiaries remain low. Without proper treatment, these patients may experience persistent depression and anxiety symptoms, difficulty co-managing other conditions, worsening functional status, and avoidable and expensive acute medical events. In 2017, Medicare launched the Quality Payment Program (QPP) to incentivize delivery of high quality, low cost, evidence-based care in the outpatient setting. Primary care providers (PCPs) are required to participate in the QPP via one of two tracks: 1) the Merit-Based Incentive Payment System (MIPS), the default track; or 2) alternative payment models (APMs) such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). In the both the APMs and MIPS, PCPs are paid for their performance based on the quality and cost of care they deliver to patients. However, the effects of these QPP models on treatment of depression and anxiety disorders by PCPs are unknown. There is a critical need for research on the effects of the APMs and MIPS on access to care and delivery of evidence- based treatment for depression and anxiety disorders in the primary care setting, as well as subsequent outcomes for patients. Our scientific premise is that the QPP, which is a program targeted at the general patient population, has conflicting incentives for primary care delivery to patients with depression and anxiety disorders. On one hand, the QPP incentivizes PCPs in ACOs and PCMHs to adopt innovative care models that may increase rates of evidence-based treatment. However, on the other hand, the QPP does not risk adjust for the most prevalent types of depression and anxiety disorders, which creates a financial disincentive to PCPs in ACOs and PCMHs for caring for patients with these conditions, potentially threatening their access to care. This negative consequence may be further magnified among patients who are poor, belong to racial and/or ethnic minority groups, or live in rural areas. The objective of this R01 application is to conduct a longitudinal study linking rich national datasets of Medicare claims, patient surveys, and PCP data from 2017-2022 to evaluate: 1) patient and PCP risk selection into the APMs vs. MIPS (Aim #1); 2) whether financial incentives to PCPs in the QPP contribute to this risk selection and how they may be remedied (Aim #2); and 3) the effect of patient care from PCPs in the APMs vs. MIPS on delivery of evidence-based treatment for depression and anxiety disorders and subsequent patient outcomes (Aim #3). We hypothesize that although patients with depression and anxiety disorders will receive higher rates of evidence-based treatment and have better outcomes when treated by PCPs participating in the APMs vs. MIPS, these patients will nonetheless be less likely to be cared for by PCPs in the APMs vs. MIPS than patients without these conditions due to negative financial consequences to their PCPs caused by inadequate risk adjustment in the QPP for these conditions.

项目摘要 抑郁症和焦虑症在初级保健环境中的患者中很常见，并且有明确的证据- 基于筛查、诊断和治疗的指南。然而，筛查和治疗率在 医疗保险受益人仍然很低。如果没有适当的治疗，这些患者可能会经历持续的 抑郁和焦虑症状，难以共同管理其他情况，功能状态恶化，以及 可避免且代价高昂的急性医疗事件。2017年，联邦医疗保险启动了质量支付计划 (QPP)鼓励在门诊环境中提供高质量、低成本、以证据为基础的护理。主要 护理提供者(PCP)需要通过以下两种途径之一参与QPP：1)基于功绩的激励 支付系统(MIPS)，默认路径；或2)替代支付模式(APM)，如责任医疗 组织(ACO)和以患者为中心的医疗之家(PCMH)。在APM和MIPS中，PCP 根据他们为患者提供的护理质量和成本来支付他们的绩效。然而， 这些QPP模型对PCP治疗抑郁症和焦虑症的效果尚不清楚。的确有 迫切需要研究非杀伤人员地雷和MIPS对获得护理和提供证据的影响- 在初级保健环境中对抑郁症和焦虑症进行基础治疗，以及随后的 患者的结果。我们的科学前提是QPP，这是一个针对一般人的计划 患者群体在为抑郁症和焦虑症患者提供初级保健方面存在相互矛盾的激励 精神错乱。一方面，QPP激励ACO和PCMH的初级保健医生采用创新的护理模式， 可能会增加循证治疗的比率。然而，另一方面，QPP不会对风险进行调整 最普遍的抑郁症和焦虑症，这在经济上对初级保健医生造成了阻碍 ACO和PCMH护理这些疾病的患者，可能威胁到他们获得护理的机会。 这种负面影响可能在贫穷、属于种族和/或 少数民族，或生活在农村地区。此R01应用程序的目标是进行纵向 这项研究将2017-2022年医疗保险申领、患者调查和PCP数据的丰富国家数据集链接到 评估：1)患者和PCP风险选择进入APM与MIPS(目标1)；2)是否有经济激励来 QPP中的PCP有助于风险选择以及如何补救它们(目标2)；以及3) APM中的PCP与MIPS在提供抑郁症循证治疗方面的患者护理 焦虑症和随后的患者结局(目标3)。我们假设，尽管患者患有 抑郁症和焦虑症将接受更高的循证治疗率，并有更好的 与MIPS相比，参加APM的PCP治疗结果仍然较少。 由于阴性，在APM与MIPS中有可能由PCP护理的患者比没有这些情况的患者更有可能得到PCP的护理 由于QPP中对这些条件的风险调整不充分而对其初级保健医生造成的财务后果。