Population Health Strategies for Reducing Surgical Costs

项目摘要 《平价医疗法案》的条款之一是在美国建立责任医疗组织（ACO）。 医疗计划。ACO承担了大量患者的经济责任。ACO成为 符合特定质量和节约基准的员工有资格获得奖金。超过2300万美国人 目前有740多个助理文书主任。ACO的早期经验表明，这是一个“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，每年进行超过5100万例住院外科手术， 5000亿美元，占所有医院和医生支出的40%。尽管如此，ACO领导人 很大程度上忽视了外科护理。通过这项研究，我们的目标是更好地了解手术成本的变化， 助理指挥官例如，一种常见的ACO策略（称为“热点定位”）是尽量降低成本， 昂贵的医疗病人。然而，我们不知道“热点”是否是一个可行的战略， 手术费用。第二，虽然我们知道不同医院的手术费用会有很大差异，但我们不知道， 我知道ACO是否可以通过将患者从高成本医院转诊到低成本医院来节省资金， 外科手术最后，还没有任何证据表明ACO可以降低手术费用。如果某些 ACO确实成功地降低了手术成本，了解他们是否使用“热点”， 选择性地这样做。我们将通过一系列使用支付的研究来解决所有这些问题 2012-2016年期间，ACO中接受18次外科手术的Medicare患者的数据。 这项研究是确定ACO可以用来降低手术成本的策略的第一步， 为今后开展旨在实施这些战略的工作提供便利。此外，该研究项目，高度 经验丰富的多学科导师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，博士。该提案 包括一个详细的教育计划与培训，这将是必不可少的成功完成这两个 研究和内森博士的职业发展。培训包括以下方面的研究生课程： 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，并成为一个独立的调查员和国家 了解和改善手术成本差异的领导者。

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.