Population Health Strategies for Reducing Surgical Costs

项目总结 《平价医疗法案》的条款之一是在#年建立负责任的医疗组织(ACO) 医疗保险计划。ACO承担起对大量患者的经济责任。ACO成为 通过达到特定的质量和储蓄基准，有资格获得奖金。超过2300万美国人 现在有740多名指挥官负责。ACOS的早期经验表明，这是一种“三赢”--降低成本， 更高的质量和更好的患者体验-ACO模式继续快速增长。 在美国，每年有超过5100万例住院外科手术，花费超过 5000亿美元，占所有医院和医生支出的40%。尽管如此，ACOS的领导人 很大程度上忽视了外科治疗。通过这项研究，我们的目标是更好地了解手术费用在 司令官。例如，一种常见的ACO策略(称为“热点定位”)就是尽可能地降低成本 昂贵的医疗病人。然而，我们不知道“热点”是否是一种可行的减少 手术费用。其次，虽然我们知道不同医院的手术费用可能有很大差异，但我们并不知道 了解ACO是否可以通过将患者从高成本医院转介到低成本医院来节省资金 外科手术。最后，目前还没有任何证据表明ACOs可以降低手术成本。如果确定 ACO确实成功地降低了手术费用，了解他们是否使用了“热点定位”和 这样做的选择性转介。我们将通过使用支付的一系列研究来解决所有这些问题 2012-2016年间，ACOS中正在接受18次手术的联邦医疗保险患者的数据。 这项研究是确定ACOS可以用来降低手术成本并将 使今后旨在执行这类战略的工作成为可能。此外，该研究项目高度 经验丰富的多学科指导团队和无与伦比的研究环境非常适合 解决候选人的职业目标和教育需求，哈里·内森，医学博士。这项建议 包括详细的教育计划和培训，这对成功完成这两项工作都是必不可少的 研究和内森博士的职业发展。培训包括研究生级别的课程 计量经济学和政策分析。这个职业发展奖将为内森博士奠定基础 进行持续的、创新的卫生服务研究，并成为独立的调查者和国家 在理解和改善手术费用差异方面处于领先地位。

PROJECT SUMMARY One of the provisions of the Affordable Care Act was to establish Accountable Care Organizations (ACOs) in the Medicare program. ACOs assume financial responsibility for large populations of patients. ACOs become eligible to receive bonuses by meeting specific quality and savings benchmarks. Over 23 million Americans are now covered by more than 740 ACOs. The early experience with ACOs suggests a “triple win”—lower costs, higher quality, and better patient experience—and the ACO model continues to grow rapidly. Over 51 million inpatient surgical procedures are performed annually in the United States at a cost of over $500 billion, accounting for 40% of all hospital and physician spending. Despite this, ACOs leaders have largely ignored surgical care. With this research, we aim to better understand surgical cost variation within ACOs. For example, a common ACO strategy (dubbed “hot-spotting”) is to try to reduce costs for the most expensive medical patients. However, we do not know whether “hot-spotting” is a viable strategy for reducing surgical costs. Second, while we know that surgical costs can vary significantly between hospitals,we do not know whether ACOs could save money by referring patients from high-cost to low-cost hospital for their surgical procedures. Finally, there is not yet any evidence that ACOs can reduce surgical costs. If certain ACOs do succeed in reducing surgical costs, it would be useful to know whether they use “hot-spotting” and selective referral to do so. We will address all of these questions through a series of studies using payment data for Medicare patients in ACOs who are undergoing 18 surgical procedures over the years 2012-2016. This research is the first step towards identifying strategies that ACOs can use to reduce surgical costs and will enable future work aimed at implementing such strategies. Furthermore, the research project, highly experienced multidisciplinary mentorship team, and unparalleled research environment are ideally suited to address the career goals and educational needs of the candidate, Hari Nathan, MD, PhD. The proposal includes a detailed educational plan with training that will be essential both for successful completion of this research and toward Dr. Nathan's career development. The training includes graduate level courses in econometrics and policy analysis. This career development award will lay the groundwork for Dr. Nathan to perform ongoing, innovative health services research, and to become an independent investigator and national leader in understanding and improving surgical cost variation.