Examining the effects of Global Budget Revenue Program on the Costs and Quality of Care Provided to Cancer Patients Undergoing Chemotherapy
检查全球预算收入计划对接受化疗的癌症患者提供的护理成本和质量的影响
基本信息
- 批准号:10734831
- 负责人:
- 金额:$ 62.41万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-09-13 至 2028-08-31
- 项目状态:未结题
- 来源:
- 关键词:Accident and Emergency departmentAcuteAddressAdoptedAdultAdverse effectsAffectAreaBudgetsCancer PatientCaringClinicalConsultationsCost ControlEmergency department visitEnrollmentEthnic OriginEvaluationFee-for-Service PlansFundingFutureGrowthHealth ExpendituresHealthcareHospitalizationHospitalsImmunotherapyIncentivesIndividualInequityInfusion proceduresInstitute of Medicine (U.S.)InsuranceLightMalignant NeoplasmsMarylandMedicaidMedicalMedicareModelingOncologistOncologyOralOutcomeOutpatientsPatient CarePatient SelectionPatientsPerformancePharmaceutical PreparationsPharmacotherapyPhysiciansPhysicians&apos OfficesPolicy MakerPopulationPriceProviderPublic HealthQuality of CareQuasi-experimentRaceReportingResearchRiskRisk AdjustmentSavingsServicesSiteStructureSystemTestingTimeTrustUnited StatesUnited States Centers for Medicare and Medicaid ServicesUpdateVariantVisitaccess disparitiesaccess restrictionsacute carebeneficiarycancer carecancer therapycare deliverycare episodecare outcomeschemotherapycostdeprivationdesigndual eligibleend of lifefinancial incentivehospice environmenthospital carehospital readmissionhospital servicesimprovedinpatient serviceinterestmarginalizationmarginalized populationmortalityoutpatient programspatient orientedpaymentpreventprogramsprospectiveracial minorityresponserisk mitigationsocialsocioeconomicstargeted treatmentwaiver
项目摘要
Project Summary/Abstract
In 2014, the state of Maryland, under a federal waiver, enacted an all-payer Global Budget Revenue (GBR)
model that prospectively set limits on hospital revenue. It also required the state to limit growth in per-capita
spending and mandated reductions in preventable complications and readmissions. GBR implementation was
associated with savings to the Medicare Trust Fund and considerations are now underway to expand the
program to other regions. However, there is limited understanding of GBR’s impact on the delivery of cancer-
related services. It is possible that while GBR may incentivize reduced healthcare expenditures and care
improvements on average, it could be associated with unintended effects and poor performance for cancer
patients by limiting access to effective cancer treatments. GBR may have deleterious effects on prevailing
cancer care inequities by encouraging adverse patient selection towards racial minorities and patients with
socioeconomic vulnerability due to concerns about higher spending and worse clinical outcomes. Current
evaluations of the GBR program have not examined these impacts. We aim to address this evidence gap in
this proposal. Our research is important because acute hospital care, the focus of GBR incentives, is a key
driver of overall spending and regional variation in spending for patients with cancer.
The objective of this proposal is to systematically examine, via a difference-in-differences design, the impact
of the GBR model on spending, quality-of-care, and utilization among fee-for-service Medicare beneficiaries
and nonelderly Medicaid and commercial insurance beneficiaries with cancer in Maryland compared with
similar patients in control states. Our central hypothesis is that the financial incentives in GBR will lower
spending, improve care quality, and facilitate a shift in the site of care for chemotherapy administration across
our populations of interest. Additionally, we hypothesize that GBR implementation will lead to relatively worse
clinical outcomes and relatively greater spending for historically marginalized patients. We will test our
hypotheses and achieve our objectives with the following specific aims: Aim 1: Quantify the impact of GBR on
risk-adjusted spending for beneficiaries undergoing chemotherapy. Aim 2: Assess the impact of GBR on the
likelihood of chemotherapy receipt and on care quality for beneficiaries undergoing chemotherapy. Aim
3: Assess the impact of GBR on the type of chemotherapy (physician-administered vs. oral) and site of
physician-administered chemotherapy (hospital outpatient department vs. physician office setting). Aim 4:
Assess the differential effects of GBR implementation on care delivery for historically marginalized patients,
based on area-level deprivation, race and ethnicity, and dual-eligible status, who are undergoing
chemotherapy. Our findings will meaningfully advance our understanding of how to deliver efficient, high-
quality cancer care to adult patients. It will also provide timely information to policy-makers that would guide
updates to GBR and mitigate the risk of unintended consequences in future global budget initiatives.
项目总结/文摘
项目成果
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