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Impact of the Merit-Based Incentive Payment System on the Quality of Prostate Cancer Care

绩效奖励制度对前列腺癌护理质量的影响

基本信息

批准号：
10535234
负责人：
Avinash Maganty
金额：
$ 8.56万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-15 至 2023-07-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10535234
关键词：
Adherence Adopted Affect Cancer Etiology Caring Categories Cessation of life Clinical Cost efficiency Data Diagnosis Diagnostic tests Disease Exposure to Fee-for-Service Plans Future Guidelines Health Health Services Accessibility Healthcare Incentives Information Technology Interruption Intervention Knowledge Lead Light Link Magnetic Resonance Imaging Malignant Neoplasms Malignant neoplasm of prostate Measures Medicare Medicare claim Medicare/Medicaid Methods Modeling Monitor Motivation Newly Diagnosed Outcome PSA screening Patient Care Patients Performance Physicians Policies Population Price Prostate Quality of Care Reporting Risk Series Standardization System Time Uncertainty United States Variant Visit Vulnerable Populations Weight Work adverse outcome base beneficiary cancer care care costs care delivery cost design dual eligible econometrics financial incentive high risk improved men mortality payment programs prostate biopsy provider behavior social success tumor progression virtual

项目摘要

PROJECT SUMMARY Prostate cancer is the second leading cause of cancer death among men in the United States. It remains a challenging disease to treat given that many men do not benefit from immediate treatment, either due to slow-progressing disease or competing risks. This uncertainty about whether and when to treat has resulted in considerable variation in the management of prostate cancer, which we have shown to be driven by non-clinical factors such as financial incentives. Fee-for- service payment models provide incentives for utilization, but this may not always lead to benefits for patients, and in some instances can be harmful. Therefore, designing payment models that advance high-value healthcare by promoting both quality and reduced spending is critical. The Merit-Based Incentive Payment System (MIPS) in fee-for-service Medicare, introduced as part of the Medicare Access and CHIP Reauthorization Act, is a payment model that aims to improve the value of care by tracking quality measures and monitoring spending. Understanding how motivations to reduce spending implied by the MIPS policy affect quality and access to prostate cancer care is crucial. As Medicare annually escalates the weight of the spending component, spending is becoming increasingly important in determining success within the program. However, incentives to reduce spending may not always align with quality care. Additionally, incentives to reduce spending may have unintended consequences. For example, physicians may be influenced to avoid vulnerable populations, who are associated with the highest cost of care and worse cancer outcomes, in order to improve their performance within the program. In light of this, understanding the impact of the policy on quality of care and access for vulnerable populations is crucial. Using national Medicare claims data linked to physician quality reporting files, we will identify the impact of MIPS on quality and access to prostate cancer care utilizing methods adopted from econometrics. We will specifically assess the policy’s impact on access to care for Medicare’s most vulnerable population, dual eligible beneficiaries. The results of our study will enhance our understanding of how MIPS may influence care for men with prostate cancer and whether it promotes inequities in the delivery of care. The findings from this study will directly inform policymakers of potential gaps within the program so the policy may be improved in future iterations to enhance patient care.

项目总结前列腺癌是美国男性癌症死亡的第二大原因。它仍然是一种具有挑战性的疾病，因为许多男性并不能立即受益治疗，要么是由于疾病进展缓慢，要么是由于相互竞争的风险。这种不确定性是否会什么时候治疗导致前列腺癌的治疗有很大的不同，我们已经证明，这是由非临床因素推动的，比如经济激励。按以下方式收费- 服务支付模式提供了使用激励，但这可能并不总是带来以下好处患者，在某些情况下可能是有害的。因此，设计预付款模式通过提高质量和减少支出来实现高价值的医疗保健至关重要。收费医疗保险中的基于功绩的激励支付系统(MIPS)，作为联邦医疗保险接入和芯片重新授权法案是一种支付模式，旨在改善通过跟踪质量措施和监控支出来实现护理价值。了解动机如何减少MIPS政策所暗示的支出会影响前列腺癌护理的质量和机会至关重要。随着联邦医疗保险每年增加支出部分的权重，支出是在决定项目成功与否方面变得越来越重要。然而，激励措施减少开支可能并不总是与高质量的医疗保健相一致。此外，减少支出的激励措施可能会产生意想不到的后果。例如，医生可能会受到影响，以避免弱势人群，他们与最高的护理费用和更严重的癌症有关结果，以改善其在方案内的表现。鉴于此，理解该政策对弱势群体的护理质量和获得机会的影响至关重要。使用链接到医生质量报告文件的全国Medicare索赔数据，我们将确定 MIPS采用的方法对前列腺癌护理质量和可获得性的影响计量经济学。我们将具体评估该政策对大多数人获得医疗保险的影响弱势群体，双重符合条件的受益人。我们的研究结果将提高我们的了解MIPS可能如何影响前列腺癌患者的护理，以及它是否促进在提供护理方面的不平等。这项研究的发现将直接告诉我们政策制定者了解计划中的潜在差距，以便在未来的迭代中可能会改进政策加强对病人的护理。