Return on Investment for Quality Improvement Collaboratives in Surgery

摘要： 出于患者结果的广泛差异，付款人实施了广泛的 旨在提高外科护理质量的举措。常见的战略包括以 卓越的计划，引导患者前往可能具有卓越结果和付费的医院- 绩效计划，奖励符合目标护理流程的医院。 最近，几个大的支付者已经开始资助州或地区级别的质量改进(Qi)。 协作。虽然它们的细节各不相同，但这些努力通常涉及收集详细的临床数据 关于过程和结果，对提供者绩效的定期反馈，以及明确 质量改进机制。这些大型QI协作的早期结果表明， 极大地改善患者预后的潜力。尽管如此，这种模式的广泛传播 由于与数据收集和计划协调相关的高成本， 每个病人从50美元到200美元不等。 然而，许多人认为，与质量改进相关的节省可能会抵消这些 成本。根据一些估计，手术并发症增加了超过11,000美元的平均付款 住院外科手术，其中大部分转嫁给付款人。医院里的变化很大 付款进一步暗示了储蓄的机会。基于我们的试点研究，使用来自 作为密歇根州的一大支付者，CABG和其他常见程序的平均总支付额各不相同 在考虑到合同价格差异后，各医院的费用增加了5,000美元以上。大号 这一差异的比例是由于非捆绑专业服务在 以入院率和30天再住院率为指标。如果这样的变化只能减少 适度地，质量改进将不仅弥补其成本，还将显著减少 手术护理的总成本。 在探索大型QI协作在外科手术中的财务影响时，我们将检查以下数据 密歇根蓝十字和蓝盾的价值合作计划(BCBSM) 迄今为止这类雄心勃勃的计划。该项目涉及全州40多家医院， 每年招收近5万名患者，每年的管理费用超过1000万美元。它的 临床范围很广，包括减肥、心脏、普通和血管外科，以及 经皮冠状动脉和外周动脉介入，从而为 检查质量改进和成本之间的关系。

ABSTRACT: Motivated by wide variation in patient outcomes, payers have implemented a broad range of initiatives aimed at improving the quality of surgical care. Common strategies include centers of excellence programs that steer patients to hospitals likely to have superior outcomes and pay-for- performance plans, which reward hospitals for compliance with targeted processes of care. Recently, several large payers have begun funding state- or regional level quality improvement (QI) collaboratives. While their details vary, these efforts generally involve collecting detailed clinical data regarding process and outcomes, regular feedback on provider performance, and explicit mechanisms for quality improvement. Early results from these large QI collaboratives indicate their potential to substantially improve patient outcomes. Nonetheless, wide dissemination of this model remains limited due to the high costs associated with data collection and program coordination which range from $50 to $200 per patient. However, many believe that savings associated with quality improvement may more than offset such costs. By some estimates, surgical complications add over $11,000 to the average payments for inpatient surgical procedures, most of which is passed on to payers. Wide variation in hospital payments further suggests opportunities for savings. Based on our pilot studies using claims from one large payer in Michigan, average total payments for CABG and other common procedures vary by more than $5,000 across hospitals, after accounting for contractual price differences. A large proportion of this variation is attributable to differences in non-bundled specialty services during the index admission and in 30-day readmission rates. If such variation could be reduced only moderately, quality improvement would not only cover its costs, but also substantially reduce the overall costs of surgical care. In exploring the financial implications of large QI collaboratives in surgery, we will examine data from the Value Partnership Program of Blue Cross and Blue Shield of Michigan (BCBSM), the most ambitious program of its type to date. This program involves more than 40 hospitals statewide, enrolls almost 50,000 patients annually, and costs over $10 million each year to administer. Its clinical scope is broad, including bariatric, cardiac, general, and vascular surgery, as well as percutaneous coronary and peripheral arterial interventions, thus providing a rich substrate for examining the relationship between quality improvement and costs.