Intended and Unintended Consequences of Nonpayment for Preventable Complications

项目概要/摘要 财务激励措施，如按业绩付费（P4P）计划， 越来越多地被用于改善医生的行为。然而，这些影响 关于提高病人护理质量的项目好坏参半， 显示出适度的收益，其他人报告说，护理质量几乎没有改善 措施此外，P4P计划的意外后果已经被 证明，包括更大的财政奖励那些医院， 为大型医院提供服务的医院的基线绩效和重大财务损失 少数族裔人口。自2008年10月1日起，Medicare实施了新的 金融机制-可预防并发症不付款（NPCC）-这是一个 “大棒”，而不是“胡萝卜”。医疗保险不再支付医院治疗某些 医疗保健相关感染（HAI），如果患者不存在于 入院 我们提出的研究是独特和及时的。没有对 NPPC的影响，这是由美国最大的支付者之一实施的。 尽管缺乏证据证明其有效性，但人们希望财政抑制措施将 激励医院和供应商集中精力减少HAI。虽然目标 当然是值得的，用于激励变革的机制应该严格 评估以确保其达到预期结果，而不会发生 意想不到的后果。我们的研究旨在了解影响，无论是积极的 NPPC对健康结果和成本的影响为负。 我们将评估医疗保险使用NPPC对结果和成本的影响， 向Medicare和国家医疗安全网络报告数据的医院 （NHSN）。我们的目的是：（1）评估NPPC对HAI率的影响， 医疗保险（即“账单”费率）;（2）评估NPPC对报告的HAI费率的影响 （即“真实”感染率）;（3）探讨NPPC是否减少了“账单” 不同类型医院的“真实”感染率（例如，营利性与非营利性）（4） 评估HAI的报销是否因NPPC而减少 不成比例地影响到照顾大部分穷人或少数民族的医院 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.