Responses to Medicare's Nonpayment for Preventable Hospital Complications

对医疗保险不支付可预防的医院并发症的回应

• 批准号: 8308285
• 负责人: TERESA M WATERS
• 金额: $ 41.48万
• 依托单位: UNIVERSITY OF TENNESSEE HEALTH SCI CTR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8308285
• 关键词: Responses; Medicare; Nonpayment; Preventable; Hospital

On October 1, 2008, Medicare implemented a policy that denies incremental payment for eight preventable complications of medical care. Even though this CMS policy is limited in terms of involved conditions, hospital reaction may be substantial because this policy change is viewed by many as the first in a series of CMS payment reforms intended to increase its emphasis on value-based purchasing, using both positive incentives and negative penalties. Hospital responses are likely to be more significant than they would be if the rule change was an isolated event rather than a precursor of future change. In addition, the negative 'stick' of non-reimbursement may be a more powerful motivator than an equal positive reward, in part because of revenue loss but also because of the negative stigma that results for an organization. We propose to examine the impact of Medicare's new nonpayment rule on hospital behavior related to four of the eight conditions identified by CMS as preventable: catheter-associated urinary tract infection rates, central line- associated blood stream infection rates, falls, and hospital-acquired pressure ulcers. We will also assess how hospital responses may vary depending on particular circumstances, such as financial health and market conditions. Specifically, we propose to address the following research questions: (1) What is the impact of the CMS payment rule change on the incidence of these four conditions? (2) How will hospital circumstances influence responses to the CMS payment rule changes? And (3) How have hospitals altered their quality improvement activities (QI) in response to the CMS payment rule changes? National Database of Nursing Quality Indicators (NDNQI) data merged with American Hospital Association Annual Survey of Hospitals data, Medicare Cost Reports, and Area Resource File data will be used to examine hospital responses to the CMS payment change using multi-level, interrupted time series models in which unit, hospital and market characteristics influence patient outcomes. Six hospitals with varying levels of outcomes improvement will be also be selected for in-depth site visits, focusing on the changes in quality improvement activities that have occurred as a result of the CMS payment policy, as well as the barriers and facilitators to change. Because of the relative novelty of negative incentives, as well as the signal that the rule change sends to hospitals about future Medicare payment changes, our study will provide vital information to policymakers and payers across the country about the extent to which such policies achieve intended results. We will also provide important information on how responses may vary depending on particular hospital circumstances, such as financial health and market conditions. Hospitals in poor financial health may lose more under the new payment rules, adding to their problems in supporting quality improvement activities. In these turbulent financial times, it is critical that payment incentives designed to improve quality of care do not have unintended effects that compromise quality due to the financial pressure they create.

2008年10月1日，医疗保险实施了一项政策，拒绝为8名 可预防的医疗并发症。尽管该CMS政策在参与方面受到限制， 在这种情况下，医院的反应可能是实质性的，因为许多人认为这一政策变化是第一次， 一系列CMS支付改革旨在增加其对基于价值的采购的重视， 积极的激励和消极的惩罚。医院的反应可能比他们想象的更重要 如果规则的变化是一个孤立的事件，而不是未来变化的前兆，那么就没有可能。此外，负 不报销的“大棒”可能比同等的积极奖励更有动力，部分原因是 这不仅是因为收入损失，也是因为给一个组织带来的负面耻辱。我们建议 检查医疗保险新的不支付规则对医院行为的影响， CMS确定为可预防的疾病：导管相关尿路感染率，中心静脉导管- 相关的血流感染率、福尔斯和医院获得性压疮。我们还将评估如何 医院的反应可能会有所不同，这取决于特定的情况，如财务状况和市场 条件具体而言，我们建议解决以下研究问题：（1） CMS缴费规则的变化对这四种情况的发病率有影响吗？(2)医院的情况如何 影响对CMS支付规则更改的响应？（3）医院如何改变其质量 针对CMS支付规则变更的改进活动（QI）？ 国家护理质量指标数据库（NDNQI）数据与美国医院合并 协会年度医院调查数据、医疗保险成本报告和地区资源文件数据将被 用于使用多水平、中断时间序列检查医院对CMS支付变化的反应 单元、医院和市场特征影响患者结局的模型。六家医院， 还将选择结果改善的水平进行深入的现场访问，重点是 由于CMS支付政策而发生的质量改进活动，以及障碍 和促进者来改变。由于负激励的相对新奇，以及 规则的变化发送到医院关于未来的医疗保险支付的变化，我们的研究将提供重要的信息 向全国各地的政策制定者和支付者介绍这些政策在多大程度上实现了预期目标， 结果我们还将提供重要的信息，说明根据具体情况， 医院的情况，如财务状况和市场状况。财务状况不佳的医院可能会 在新的支付规则下，损失更多，增加了他们在支持质量改进活动方面的问题。 在这个动荡的金融时代，旨在提高医疗质量的支付激励措施至关重要。 不会由于它们产生的财务压力而产生损害质量的意外影响。

项目成果

Ongoing Attention to Injurious Inpatient Falls and Pressure Ulcers--Reply.

对住院患者跌倒和压疮的持续关注——答复。

• DOI: 10.1001/jamainternmed.2015.2568
• 发表时间: 2015
• 期刊: JAMA internal medicine
• 影响因子: 39
• 作者: Waters,TeresaM;Daniels,MichaelJ;Bazzoli,GloriaJ;HospitalResponsestoMedicare’sNonpaymentforPreventableComplications(HRMNPC)Team
• 通讯作者: HospitalResponsestoMedicare’sNonpaymentforPreventableComplications(HRMNPC)Team