Improving Inpatient Psychiatric Payment: Cost and Quality Implications

改善住院精神科付款：对成本和质量的影响

• 批准号: 7321446
• 负责人: DONALD Michael STEINWACHS
• 金额: $ 67.2万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-25 至 2010-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7321446
• 关键词: Adam11 gene; Admission activity; Advisory Committees; Agreement; Algorithms; CCL22 gene; Caring; Categories; Characteristics; Charge; Classification; Code; Collaborations; Collection; Data; Data Collection; Data Element; Data Sources; Diagnosis-Related Groups; Diagnostic; Disease; Ensure; Evidence based treatment; Failure; General Hospitals; Goals; Gray unit of radiation dose; Health; Health Information System; Health Services; Health system; Hospitalization; Hospitals; ICD-9-CM; Incentives; Individual; Inpatients; Laws; Length; Length of Stay; Link; Maintenance; Maryland; Measurement; Measures; Medicaid; Medical; Medical Records; Medicare; Medicare/Medicaid; Mental Health; Mental Health Services; Mental disorders; Modernization; Monitor; Operative Surgical Procedures; Patients; Performance; Personal Communication; Phase; Pilot Projects; Policies; Process; Prospective Payment System; Psychiatric therapeutic procedure; Psychiatry; Quality Indicator; Rate; Relative (related person); Reporting; Research; Resources; Risk; Services; Severities; Simulate; Son; Surveys; System; Testing; United States Centers for Medicare and Medicaid Services; Variant; Weight; Work; abstracting; authority; base; billing data; chlorambucil/dactinomycin/methotrexate protocol; cost; day; improved; inpatient service; insight; medical specialties; member; models and simulation; parity; patient safety; payment; programs; prospective; willingness

DESCRIPTION (provided by applicant): Medicare Prospective Payment System (PPS) for inpatient hospital care has used Diagnostic Related Groups (DRG) to pay "per case" since its implementation in 1983, except for psychiatric disorders. Per case payment has demonstrated its incentives for efficiency in Medicare's payment for inpatient medical care yet most of inpatient psychiatric care is paid per diem, including the new CMS psychiatric prospective payment system. For psychiatric admissions, DRGs explain a little less than 2% of costs per case. Recent research points to several contributing factors, among them failure to capture in billing data resource predictive characteristics, e.g., admission/severity status and treatments provided. The proposed research seeks to improve psychiatric DRGs (as implemented by CMS) and APR-DRGs (as developed by 3M Health Information Systems and used by Maryland's all payer per case payment system). This goal appears achievable with better use of billing data, plus supplemental data that could be captured from medical records. Also, the study will pilot the collection of inpatient psychiatric performance (quality) measures, including patient safety and post-discharge measures. The pilot will provide insight into the quality performance of the Maryland system under per case payment and make it possible to simulate potential effects on costs and payments of pay for performance for inpatient psychiatry. The cost of collecting additional data elements for casemix classification and for performance measurement will be assessed. The research will test hypotheses and use simulation modeling to examine the explanatory power of improved DRGs and APR-DRGs, effects of improved casemix measures on the distribution of revenues relative to costs at the hospital-level, and the relationship of performance to hospital and patient characteristics. The research will be undertaken in collaboration with the State of Maryland Health Services Cost Review Commission (HSCRC) and Maryland Mental Hygiene Administration (MHA). The HSCRC has authority under State law, operating with Medicare/Medicaid waivers, to set hospital rates for all payers in Maryland. The findings of this research are expected to be applied in Maryland by the HSCRC. In addition, the project has a Policy Advisory Committee with broad representation that will ensure national relevance.

描述（由申请人提供）：用于住院治疗的医疗保险预期支付系统 (PPS) 自 1983 年实施以来一直使用诊断相关组 (DRG) 来“按病例”支付费用，精神疾病除外。按病例付费已经证明了其对 Medicare 住院医疗护理支付效率的激励作用，但大多数住院精神科护理是按日支付的，包括新的 CMS 精神科预期支付系统。对于精神科入院，DRG 解释的每个病例的费用略低于 2%。最近的研究指出了几个影响因素，其中包括未能捕获计费数据资源的预测特征，例如入院/严重程度状态和提供的治疗。拟议的研究旨在改进精神科 DRG（由 CMS 实施）和 APR-DRG（由 3M 健康信息系统开发并由马里兰州按病例付费系统使用）。通过更好地利用计费数据以及可以从医疗记录中捕获的补充数据，这一目标似乎可以实现。此外，该研究还将试点收集住院患者精神科表现（质量）指标，包括患者安全和出院后指标。该试点项目将深入了解马里兰州系统按病例付费的质量绩效，并可以模拟住院精神病学绩效付费对成本和支付的潜在影响。将评估收集用于案例组合分类和绩效衡量的额外数据元素的成本。该研究将测试假设并使用模拟模型来检验改进的 DRG 和 APR-DRG 的解释力、改进的案例组合措施对医院层面相对于成本的收入分配的影响，以及绩效与医院和患者特征的关系。该研究将与马里兰州卫生服务成本审查委员会 (HSCRC) 和马里兰州精神卫生管理局 (MHA) 合作进行。根据州法律，HSCRC 有权在医疗保险/医疗补助豁免的情况下为马里兰州所有付款人确定医院费率。 HSCRC 预计这项研究的结果将在马里兰州应用。此外，该项目还设有一个具有广泛代表性的政策咨询委员会，以确保国家相关性。