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The impact of population and episode-based payment models on surgical disparities

人口和基于事件的支付模式对手术差异的影响

基本信息

批准号：
10494060
负责人：
Said A Ibrahim
金额：
$ 65.89万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-23 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10494060
关键词：
Accountability Affect Caring Coronary Artery Bypass Data Excision Face Fee-for-Service Plans Grouping Hospitalization Hospitals Incentives Individual Insurance Coverage Intestines Length of Stay Lower Extremity Medicaid Medicare Methodology Modeling Operative Surgical Procedures Outcome Patient Care Patient Selection Patient-Focused Outcomes Patients Performance Physicians Policies Population Procedures Provider Replacement Arthroplasty Research Risk Services Socioeconomic Status Spinal Fusion Surgeon Time Vulnerable Populations acute care base black patient bundled payment care costs care episode care providers cost design econometrics ethnic minority population experience experimental study hospital readmission innovation inpatient surgery insight low socioeconomic status model design mortality patient population payment peer population based racial and ethnic scale up surgical disparities

项目摘要

Project Summary As a prominent leader in the nationwide shift towards value-based payment, Medicare has implemented large fee-for-service population- and episode-based alternative payment models (APMs) that hold organizations financially accountable for the quality and costs of care. However, these APMs are not designed to protect access or outcomes for racial/ethnic minorities and individuals with low socioeconomic status. These vulnerable groups already face significant surgical disparities compared to other individuals. These disparities could worsen further under both APM types if participating providers engage in patient selection that reduces vulnerable patients’ access to surgical procedures or changes their care after participating. Because policymakers must make critical decisions about how to use different APMs to catalyze nationwide reform, insight about how population- and episode-based APMs affect surgical disparities for vulnerable patients can help policymakers determine how to best design, refine, implement policy adjustments, and scale up different models to safeguard the care of vulnerable patients. This study examines how prominent Medicare fee-for- service population- and episode-based APMs that are highly relevant to surgical care affect disparities in surgical access and outcomes for vulnerable patients, across insurance coverage type, and whether effects vary by providers’ financial attributes related to APM incentives. We hypothesize that APM participation will be associated with widened disparities in surgical access and outcomes (quality, utilization, and cost) for vulnerable vs. non-vulnerable patients after providers begin participating in APMs. We also hypothesize that the impact on surgical disparities will vary by providers’ financial attributes – experience with financial risk and payer mix – related to APM incentives.

项目概要作为全国范围内向基于价值的支付转变的杰出领导者，医疗保险已经实施了大量的持有组织的基于服务人群和事件的替代支付模型 (APM) 对护理质量和费用承担财务责任。然而，这些 APM 并非旨在保护种族/族裔少数群体和社会经济地位较低的个人的获取或结果。这些与其他人相比，弱势群体已经面临着巨大的手术差异。这些差异如果参与提供者进行的患者选择减少了患者的数量，那么在这两种 APM 类型下可能会进一步恶化弱势患者参与外科手术或在参与后改变他们的护理。因为政策制定者必须就如何使用不同的 APM 来促进全国性改革做出关键决定，了解基于人群和事件的 APM 如何影响弱势患者的手术差异帮助政策制定者确定如何最好地设计、完善、实施政策调整，并扩大不同的政策范围保护弱势患者护理的模型。这项研究探讨了医疗保险费用的显着程度- 与手术护理高度相关的基于服务人群和基于事件的 APM 会影响手术护理的差异不同保险承保类型中弱势患者的手术机会和结果，以及是否会产生影响因提供商与 APM 激励措施相关的财务属性而异。我们假设 APM 参与将是与手术途径和结果（质量、利用率和成本）的扩大差异相关提供者开始参与 APM 后，弱势患者与非弱势患者的比较。我们还假设对手术差异的影响将因提供者的财务属性而异——财务风险的经验和付款人组合 – 与 APM 激励措施相关。