Hospital-Physician Gainsharing

医院与医生利益共享

• 批准号: 7942746
• 负责人: Jonathan David Ketcham
• 金额: $ 21.17万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7942746
• 关键词: Hospital; Physician; Gainsharing

DESCRIPTION (provided by applicant): Health care costs continue to grow quickly in the U.S., but the value of this spending is uncertain. Fragmentation and misaligned financial incentives among physicians and between hospitals and physicians inhibit value-based decision-making. In service areas such as cardiology and orthopedic surgery, physicians determine the use of high cost drugs and devices known as "physician preference items," but hospitals pay for them. Some payers and providers have adopted group-based incentive programs to improve alignment. One known as gainsharing is currently used by hospitals in the private sector as well as within Centers for Medicare and Medicaid demonstration programs. Under gainsharing, a physician groups receives a payment that must be equally shared among its members if costs are lowered relative to a historical baseline. The broad objective of this project is to increase the value of health care decision-making through improved design of physician incentive programs. In preliminary work, we found that the programs implemented before the end of 2006 reduced costs without reductions in the available measures of quality or access. A completed theoretical model provides insights to how hospitals and physicians make decisions under gainsharing's incentives. The proposed work builds off these results to achieve three specific aims: 1) to determine whether gainsharing reduces utilization and hospitals' prices of drugs and devices, and how any price reductions are achieved; 2) to determine whether gainsharing promotes coordination and standardization of physicians' treatment decisions; 3) to demonstrate how physicians vary in their responses to gainsharing. The project also includes one exploratory aim: to develop and test economic models that accurately predict physicians' responses to alternative incentive programs, including differently designed gainsharing programs. To achieve these goals, we propose to examine all of the private-sector gainsharing programs in cardiology implemented before the end of 2009. This covers up to 25 gainsharing programs at 13 hospitals, with six programs currently pending government approval. We rely on a rich, proprietary dataset from 2001-2009 that includes all of these gainsharing programs as well as contemporaneous data from approximately 130 other, non-gainsharing coronary catheterization laboratories. These data include detailed information about every drug and device chosen by every physician for every patient, including the price the hospital paid for them. They also include a more detailed set of risk-adjustment variables than available in administrative data. The project has three main steps: we determine how physicians responded to gainsharing by empirically testing the hypotheses from the theoretical model; we discover why physicians' responses to gainsharing varied by extending and testing the model; and we quantify how physicians weigh each aspect of the incentive program by developing a structural model. The results can provide timely insights to regulators, policymakers, and managers as they consider various incentive programs to promote value through coordination.

描述（由申请人提供）：美国的医疗保健费用继续快速增长，但这笔支出的价值是不确定的。医生之间以及医院和医生之间的分散和不一致的财务激励抑制了基于价值的决策。在心脏病学和整形外科等服务领域，医生决定使用被称为“医生偏好项目”的高成本药物和设备，但医院支付费用。一些付款人和供应商采用了基于群体的激励计划，以提高一致性。一种被称为收益分享的方法目前被私营部门的医院以及医疗保险和医疗补助示范项目中心使用。根据收益分享，如果成本相对于历史基线降低，医生团体收到的报酬必须在其成员中平均分配。 该项目的广泛目标是通过改进医生激励计划的设计来增加医疗保健决策的价值。在初步工作中，我们发现，在2006年底之前实施的计划降低了成本，而没有减少可用的质量或访问措施。一个完整的理论模型提供了见解，医院和医生如何作出决定下的收益分享的激励。拟议的工作建立在这些结果的基础上，以实现三个具体目标：1）确定收益分享是否会降低药物和设备的利用率和医院的价格，以及如何实现任何价格降低; 2）确定收益分享是否会促进医生治疗决策的协调和标准化; 3）展示医生如何在他们的反应不同的收益分享。该项目还包括一个探索性目标：开发和测试经济模型，准确预测医生对替代激励计划的反应，包括不同设计的收益分享计划。 为了实现这些目标，我们建议审查2009年底前实施的所有心脏病学私营部门收益分享计划。这包括13家医院的25个收益分享计划，其中6个计划目前正在等待政府批准。我们依赖于2001-2009年丰富的专有数据集，其中包括所有这些收益共享计划以及来自大约130个其他非收益共享冠状动脉导管插入实验室的同期数据。这些数据包括每位医生为每位患者选择的每种药物和设备的详细信息，包括医院为它们支付的价格。它们还包括一套比行政数据更详细的风险调整变量。该项目有三个主要步骤：我们确定医生如何回应从理论模型的假设进行实证检验的收益分享;我们发现为什么医生的收益分享的反应不同的扩展和测试模型;我们量化医生如何权衡每个方面的激励计划，通过开发一个结构模型。研究结果可以为监管机构、政策制定者和管理者提供及时的见解，帮助他们考虑通过协调来促进价值的各种激励计划。