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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.

项目概要前列腺癌是美国男性癌症死亡的第二大原因。它鉴于许多男性无法立即受益，因此仍然是一种难以治疗的疾病由于疾病进展缓慢或竞争风险而无法接受治疗。这种不确定性是否何时治疗导致前列腺癌的治疗存在很大差异，我们已经证明这是由经济激励等非临床因素驱动的。收费- 服务付费模式提供了使用激励，但这可能并不总能带来好处患者，并且在某些情况下可能是有害的。因此，设计能够推进的支付模式通过提高质量和减少支出来实现高价值医疗保健至关重要。按服务收费的医疗保险中基于绩效的激励支付系统 (MIPS)，作为一部分引入医疗保险准入和 CHIP 再授权法案的一部分，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体现护理价值。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获取机会至关重要的。随着医疗保险每年增加支出部分的权重，支出正在在决定项目成功方面变得越来越重要。然而，激励措施减少支出可能并不总是与优质护理相一致。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而避免弱势群体，他们的护理费用最高，癌症更严重结果，以提高他们在计划中的表现。有鉴于此，了解该政策对弱势群体的护理质量和获得服务的影响至关重要。使用与医生质量报告文件相关联的国家医疗保险索赔数据，我们将确定 MIPS 采用的方法对前列腺癌护理的质量和可及性的影响计量经济学。我们将专门评估该政策对 Medicare 大部分成员获得医疗服务的影响弱势群体，双重合格受益人。我们的研究结果将增强我们了解 MIPS 如何影响前列腺癌男性的护理以及是否促进护理服务的不平等。这项研究的结果将直接告知政策制定者了解计划中的潜在差距，以便在未来的迭代中改进政策以加强患者护理。