Intended and Unintended Consequences of Nonpayment for Preventable Complications

项目概要/摘要 财务激励措施，例如按绩效付费 (P4P) 计划 越来越多地用于改善医生行为。然而，这些影响 提高患者护理质量的计划混杂在一起，其中一些研究 显示出适度的收益，而其他人则报告护理质量几乎没有改善 措施。此外，P4P 程序产生了意想不到的后果 已证明，包括对那些具有较高水平的医院给予更大的经济奖励 为大型医院提供基线绩效和重大财务损失 少数民族人口。自 2008 年 10 月 1 日起，Medicare 开始使用新的 财务机制——可预防并发症不付费（NPCC）——这是一个 “大棒”而不是“胡萝卜”。医疗保险不再向医院支付治疗某些疾病的费用 如果患者不在场，则会出现医疗保健相关感染 (HAI) 入场。 我们提出的研究是独特且及时的。没有任何评价 NPPC 的影响，该计划由美国最大的付款人之一实施。 尽管缺乏证据证明其功效，但希望财政抑制措施能够起到作用 激励医院和医疗服务提供者集中精力减少医院感染。虽然目标 当然值得，用于激励变革的机制应该严格 进行评估以确保其达到预期结果而不发生 意想不到的后果。我们的研究旨在了解其积极影响 NPPC 对健康结果和成本的负面影响。 我们将评估 Medicare 使用 NPPC 对结果和成本的影响 向医疗保险和国家医疗安全网络报告数据的医院 （NHSN）。我们的目标是： (1) 评估 NPPC 对 HAI 率的影响 医疗保险（即“计费”费率）； (2) 评估 NPPC 对报告的 HAI 率的影响 按 NHSN（即“真实”感染率）； （3）探讨NPPC是否减少了双方的“账单” 以及不同类型医院的“真实”感染率（例如营利性医院与非营利性医院）(4) 评估 NPPC 是否会导致 HAI 报销减少 对照顾大量穷人或少数族裔的医院造成不成比例的影响 患者。

Project Summary/Abstract Financial incentives, such as pay-for-performance (P4P) programs, are increasingly being used to improve physician behavior. However, the impact of these programs on improving quality of care for patients have been mixed, with some studies showing modest gains and others reporting little to no improvement on quality of care measures. Furthermore, unintended consequences of P4P programs have been demonstrated, including larger financial rewards for those hospitals with higher performance at baseline and significant financial losses for hospitals that serve large minority populations. As of October 1, 2008, Medicare implemented the use of a new financial mechanism-nonpayment for preventable complications (NPCC)-which is a "stick" rather than a "carrot". Medicare no longer pays hospitals for treating certain healthcare-associated infections (HAIs) that arise in patients if they are not present on admission. Our proposed research is unique and timely. There are no evaluations of the impact of NPPC, which is being implemented by one of the largest payers in the U.S. Despite lack of evidence for its efficacy, it is hoped that financial disincentives will motivate hospitals and providers to focus their efforts on reducing HAIs. While the goal is certainly worthy, the mechanism being used to motivate change should be rigorously evaluated to ensure that it achieves its intended consequence without the occurrence of unintended consequences. Our research seeks to understand the impact, both positive and negative, of NPPC on health outcomes and costs. We will assess the impact of Medicare's use of NPPC on outcomes and costs in hospitals that report data to Medicare and the National Healthcare Safety Network (NHSN). Our aims are: (1) To evaluate the impact of NPPC on HAI rates reported by Medicare (i.e. "billing" rates); (2) To evaluate the impact of NPPC on HAI rates reported by NHSN (i.e. "true" infection rates); (3) To explore whether NPPC reduces both "billing" and "true" infection rates in different types of hospitals (e.g. for-profit vs. not-for-profit) (4) To assess whether reduced reimbursement for HAIs as a result of NPPC disproportionately affects hospitals that care for a high proportion of poor or minority patients.