Evaluating Policies for Improving Surgical Care in the Elderly

摘要 评估改善老年人外科护理的政策 2010年的《平价医疗法案》（ACA）大大加快了新政策的采用速度 旨在降低成本和提高质量。ACA包括几项试点测试或扩大规模的任务 现有的支付改革，激励改善医疗保险患者的护理。在何种程度上这些 然而，政策是否能有效地改善手术结果和降低手术费用尚不清楚。虽然 其中一些政策以前是作为医疗保险试点计划实施的，许多政策还处于早期阶段。 阶段，并没有得到严格的评估。由于CMS的这些努力具有实质性的方案性意义， 和机会成本，了解其有效性和相对价值至关重要。因此我们 建议系统评估这些政策选择对外科护理质量和成本的影响， 全国医保人口。考虑到这些目标，我们目前的提案有以下目标：目标1。 评价CMS改进政策对手术结局的影响。我们将进行评估， 三项新的政策战略（不为不良事件付费、捆绑式付费和负责任护理 在接受住院手术的国家医疗保险人口中。对于每一种政策，我们 将利用自然实验（即，最近实施的特定计划或政策 执行）。目标2.为了评估CMS改进政策对医疗保险支付的影响， 外科手术对于这些相同的政策，我们将评估其对价格标准化医疗保险的影响 支付手术期间的所有服务费用。使用先前定义的护理片段， 我们将研究这些政策对医疗保险支付的影响，这些政策可能与并发症有关。 和低质量的护理，包括指数住院，医生服务，再入院， 急性期后护理目标3.评估CMS改进政策对弱势群体的意外后果 医保患者我们将评估这些政策是否在这些医院内造成了意外伤害 服务于弱势医疗保险人群（例如，医院为比例过高的少数群体提供服务 低收入人群）。我们将评估医疗保险支付惩罚（或奖励）的程度 从这些政策不同的医院服务弱势（与不太脆弱）人群。结果从这个 研究对CMS决策者产生了最直接的影响。这些结果将有助于基于证据的 通过提供关于这些政策选择的相对有效性的数据，促进政策制定。

Abstract Evaluating policies for improving surgical care in the elderly The 2010 Affordable Care Act (ACA) dramatically accelerated the pace of adoption for new policies aimed at reducing costs and improving quality. The ACA included several mandates to pilot test or scale up existing payment reforms that incentivized improved care for Medicare patients. The extent to which these policies will be effective at improving outcomes and reducing costs in surgery is unknown, however. Although some of these policies were previously implemented as Medicare Pilot programs, many are in their early stages and have not been rigorously evaluated. Because these efforts by CMS have substantial programmatic and opportunity costs, understanding their effectiveness and comparative value is essential. We therefore propose a systematic evaluation of the impact of these policy options on the quality and cost of surgical care in the national Medicare population. With these goals in mind, our current proposal has the following aims: Aim 1. To evaluate the impact of CMS improvement policies on surgical outcomes. We will conduct evaluations of three new policy strategies (non-payment for adverse events, bundled payments, and accountable care organizations) in the national Medicare population undergoing inpatient surgery. For each policy approach, we will take advantage of a natural experiment (i.e., a specific program or policy implemented that was recently implemented). Aim 2. To evaluate the impact of CMS improvement policies on Medicare payments around the surgical episode. For these same policies, we will evaluate their impact on price-standardized Medicare payments for the full range of services around surgical episodes. Using previously defined episodes of care for surgery, we will study the impact of these policies on Medicare payments that can be linked to complications and poor quality care, including payments for the index hospitalization, physician services, readmissions, and post-acute care. Aim 3. To evaluate the unintended consequences of CMS improvement policies on vulnerable Medicare patients. We will assess whether these policies resulted in unintended harm within those hospitals that serve vulnerable Medicare populations (e.g., hospitals serving a disproportionate share of minorities and/or low income beneficiaries). We will assess the degree to which Medicare payment penalties (or rewards) from these policies vary across hospitals serving vulnerable (vs. less vulnerable) populations. Results from this study have the most immediate impact on CMS policymakers. These results will facilitate evidence-based policymaking by providing data on the comparative effectiveness of these policy options.