Intended and Unintended Consequences of Nonpayment for Preventable Complications

项目摘要/摘要 财政激励措施，如绩效工资(P4P)计划， 越来越多地被用来改善医生的行为。然而，这些影响 关于提高患者护理质量的计划参差不齐，还有一些研究 显示出小幅增长，其他报告的护理质量几乎没有改善 措施。此外，P4P计划的意外后果一直是 示范，包括为那些拥有更高收入的医院提供更大的经济回报 为大型医院提供服务的医院的基线业绩和重大财务损失 少数族裔人口。自2008年10月1日起，Medicare实施了新的 财务机制-不支付可预防并发症(NPCC)-这是一种 “大棒”而不是“胡萝卜”。医疗保险不再为某些疾病的治疗向医院付费 医疗保健相关感染(HAI)，如果患者没有出现在 入场。 我们提出的研究是独一无二的，也是及时的。没有对这一事件的评估 NPPC的影响，该项目正由美国最大的付款人之一实施。 尽管缺乏其有效性的证据，但人们希望经济上的阻碍将 激励医院和医疗服务提供者将精力集中在减少医院感染上。虽然目标是 当然是值得的，用来推动变革的机制应该严格 评估以确保其达到预期结果而不发生 意想不到的后果。我们的研究试图了解影响，两者都是积极的 NPPC对健康结果和成本的负面影响。 我们将评估医疗保险使用NPPC对年内结果和成本的影响 向联邦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对以下报告的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 NHSN(即“真实”感染率)；(3)探索NPPC是否降低了这两个“账单” 以及不同类型医院的“真实”感染率(例如营利性与非营利性)(4) 评估NPPC是否导致医保报销减少 对照顾高比例穷人或少数族裔的医院造成不成比例的影响 病人。

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.