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Financial Incentives and Treatment of Medicare Patients with Spine Problems

患有脊柱问题的医疗保险患者的经济激励和治疗

基本信息

批准号：
8235906
负责人：
Jean M Mitchell
金额：
$ 38.27万
依托单位：
GEORGETOWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-15 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8235906
关键词：
Accounting Address Affect Age Ambulatory Surgical Procedures Area Back Back Pain Caring Characteristics Chronic Clinical Data Elderly Employee Expenditure Fees Government Growth Guidelines Health Health Policy Health Status Health system Healthcare High Prevalence Hospitals Image Injection of therapeutic agent Insurance Link Marketing Medical Medicare Medicare claim Operative Surgical Procedures Outcome Outpatients Ownership Patients Pattern Patterns of Care Persons Physical therapy Physician&apos s Practice Patterns Physicians Policies Practice Guidelines Prevalence Procedures Provider Research Resources Services Spinal Spinal Diseases Surveys Time Training Variant Vertebral column aged beneficiary cost experience financial incentive financial relationship geographic difference insight interest medical specialties public health relevance

项目摘要

DESCRIPTION (provided by applicant): Back/spine problems are extremely common, affecting about 30% of persons over age 45. Although prevalence has remained steady for nearly three decades, rates of spinal surgery, injections, advanced imaging and physical therapy to treat back/spine disorders have increased significantly, suggesting that treatment of back/spine problems has become more resource intensive. Moreover, there is considerable geographic variation in spinal surgery, which does not appear to be justified by clinical or scientific evidence. Possible explanations include lack of clear practice guidelines, financial incentives to perform more surgery and differences in clinical training. No studies investigate whether more resource intensive treatments and higher spending, either over time or across areas, result in better patient outcomes. Given the expected growth in the number of Medicare beneficiaries and expenditures, it is critical to evaluate the efficiency of Medicare's spending for back/spine problems. This project poses two research questions. The first addresses whether financial incentives linked to physician ownership of either specialty hospitals or ambulatory surgery centers (ASCs) affect patterns of care for Medicare beneficiaries with back/spine disorders. Specifically, do Medicare back/spine patients treated by physicians with an apparent financial interest in specialty hospitals or ASCs have higher expenditures than other Medicare back/spine patients? Second, if these Medicare patients do receive more intensive treatment for their back/spine problems, do they have better health outcomes, controlling for baseline health status and other sociodemographic characteristics? The project will examine these significant policy questions using the Medicare Current Beneficiary Surveys linked to Medicare claims data spanning the years 2002- 2007. The analysis will compare Medicare beneficiaries with back/spine problems treated by three types of providers: 1) physicians with financial interests (relationships) in specialty hospitals or ASCs; 2) physicians who are employed by a hospital or health system; and 3) physicians who have no direct financial relationship with a specialty hospital or ASC. PUBLIC HEALTH RELEVANCE: The findings will provide new insights on a critical health policy issue-whether greater resource intensity is associated with improvements in health and overall functioning. The results will indicate whether financial incentives result in higher spending per beneficiary and if so, whether such expenditures represent inefficiency, where the costs exceed the benefits, or represent a health-spending tradeoff. Such information will be of significant value to government and private payers, employers and consumers who are concerned about escalating health care spending and insurance premiums. Moreover, such information will be highly relevant regarding the ongoing debate over how to control Medicare and other health care spending.

描述（由申请人提供）：背部/脊柱问题是非常常见的，影响约30%的45岁以上的人。尽管近三十年来患病率保持稳定，但治疗背部/脊柱疾病的脊柱手术、注射、先进成像和物理治疗的比例显着增加，这表明背部/脊柱问题的治疗已变得更加资源密集型。此外，脊柱手术在地理上存在相当大的差异，这似乎没有临床或科学证据证明是合理的。可能的解释包括缺乏明确的实践指南，进行更多手术的经济激励以及临床培训的差异。没有研究调查更多的资源密集型治疗和更高的支出，无论是随着时间的推移还是跨领域，是否会导致更好的患者结果。鉴于医疗保险受益人和支出的预期增长，评估医疗保险用于背部/脊柱问题的支出效率至关重要。这个项目提出了两个研究问题。第一个地址是否与专科医院或门诊手术中心（ASCs）的医生所有权的经济激励影响模式的医疗保险受益人背部/脊柱疾病。具体来说，由在专科医院或ASC中具有明显经济利益的医生治疗的医疗保险背部/脊柱患者的支出是否高于其他医疗保险背部/脊柱患者？第二，如果这些医疗保险患者确实接受了更强化的背部/脊柱问题治疗，他们是否有更好的健康结果，控制基线健康状况和其他社会人口特征？该项目将使用与2002- 2007年医疗保险索赔数据相关联的医疗保险当前受益调查来研究这些重要的政策问题。该分析将比较由三种类型的提供者治疗的背部/脊柱问题的医疗保险受益人：1）在专科医院或ASC中有经济利益（关系）的医生; 2）受雇于医院或卫生系统的医生; 3）与专科医院或ASC没有直接财务关系的医生。公共卫生关系：这些发现将为一个关键的卫生政策问题提供新的见解，即更大的资源密集度是否与健康和整体功能的改善有关。结果将表明，财政激励措施是否会导致每个受益人的支出增加，如果是，这种支出是否代表效率低下，成本超过收益，或代表卫生支出的权衡。这些信息将对政府和私人支付者、雇主和消费者具有重要价值，因为他们担心医疗保健支出和保险费不断上升。此外，这些信息将与正在进行的关于如何控制医疗保险和其他医疗保健支出的辩论高度相关。