Hospital Payment Incentives and Opioid Prescribing

医院付款激励和阿片类药物处方

• 批准号: 9788406
• 负责人: Dhaval M. Dave
• 金额: $ 20.2万
• 依托单位: NATIONAL BUREAU OF ECONOMIC RESEARCH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9788406
• 关键词: Address; Admission activity; Affect; Affordable Care Act; Age; Behavior; Caring; Cessation of life; Characteristics; Client satisfaction; Data; Dependence; Drug Prescriptions; Epidemic; Evaluation; Event; Excision; Gender; Health; Heterogeneity; High Prevalence; Hospitalists; Hospitalization; Hospitals; Human; Incentives; Individual; Influentials; Information Systems; Inpatients; Knowledge; Length of Stay; Letters; Link; Maryland; Measures; Medicare; Medicare Part A; Mission; Morphine; Natural experiment; Nurses; Operative Surgical Procedures; Opioid; Opioid Analgesics; Orthopedic Surgery procedures; Outpatients; Overdose; Pain; Pain management; Pathway interactions; Patients; Pattern; Performance; Persons; Pharmaceutical Preparations; Physicians; Play; Policies; Population; Private Sector; Procedures; Provider; Recording of previous events; Reporting; Research; Role; Sentinel; Services; Surveys; Testing; Time; United States Centers for Medicare and Medicaid Services; Voice; base; beneficiary; critical access hospital; economic cost; evidence base; experience; improved; inpatient service; medical specialties; milligram; nonmedical use; opioid abuse; opioid epidemic; opioid therapy; opioid use; overdose death; payment; prescription opioid; programs; response

Project Summary/Abstract Over 216,000 individuals have died from overdoses related to opioid pain relievers between 1999-2015, making this the deadliest drug-related epidemic in U.S. history. The opioid crisis has in part been fueled by the prescribing behavior of physicians, with the amount of opioids prescribed per person in 2015 being three times higher (640 MME – morphine milligram equivalent) than in 1999. Prescribing of opioids within the hospital setting and at time of discharge may be an important, albeit understudied, pathway through which new initiates of opioid therapy may develop longer term use and dependence. Some 56 million patients receive opioid medications following surgery each year, and persistent opioid use after surgery among previously opioid- naïve patients has become increasingly common. To address the opioid epidemic, it is imperative that all potential factors be examined and studied. There is growing concern that one of these may be provider payment incentives. Under the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Value-Based Purchasing Program (HVBP), directly tying incentive payments to Medicare patients' experience of care, of which pain management is a component. Many have raised the concern that providers may be prescribing opioids unnecessarily for the express purpose of improving their patient experience metrics, concerns which were voiced by Senators Dianne Feinstein and Charles Grassley in their letter urging CMS to consider, study, and address this link between patient satisfaction-based reimbursement and opioid prescribing and also voiced by 26 senators in a similar missive to the Secretary of Health and Human Services. CMS acknowledged the lack of a rigorous evidence base on this issue, a point recently echoed in the July 2017 interim report of the White House opioid commission that underscored the need for a thorough examination of the role played by patient satisfaction and pain level as criteria through which providers are evaluated and paid. The proposed research will address this knowledge gap and provide some of the first empirical evidence on whether, and to what extent, linking hospital reimbursement to patient experience of care metrics affects opioid prescribing during inpatient care and post-discharge, and how it affects longer-term opioid use. The project will link Medicare Part A claims and Medicare Part D event data, and exploit the natural experiment provided by the introduction of Medicare's HVBP in October 2012 to most, but not all hospitals, to estimate plausibly causal effects. The project will also exploit the removal of the pain management questions from HVBP starting in FY2018 to further disentangle these effects. With the private sector following Medicare's suit in giving patient experience of care a larger role in calculating payments, the effects can propagate beyond Medicare, and the proposed study has broader implications in understanding any potential unintended consequences of tying patient experience measures to payment incentives.

项目概要/摘要 1999年至2015年间，超过216,000人死于与阿片类止痛药相关的过量服用， 使其成为美国历史上最致命的毒品相关流行病。阿片类药物危机的部分原因是 医生的处方行为，2015 年每人开出的阿片类药物数量是其三倍 比 1999 年更高（640 MME – 吗啡毫克当量）。 医院内阿片类药物处方 环境和出院时可能是一个重要的途径，尽管尚未得到充分研究，新人可以通过该途径开始 阿片类药物治疗可能会产生长期使用和依赖性。约 5600 万患者接受阿片类药物治疗 每年手术后服用药物，以及以前使用阿片类药物的患者术后持续使用阿片类药物 幼稚患者已变得越来越普遍。为了应对阿片类药物泛滥，所有国家都必须 对潜在因素进行检查和研究。人们越来越担心其中之一可能是提供商 付款奖励。根据《平价医疗法案》，医疗保险和医疗补助服务中心 (CMS) 实施医院基于价值的采购计划 (HVBP)，将奖励金直接与 医疗保险患者的护理体验，其中疼痛管理是其中的一个组成部分。许多人提出了 担心医疗服务提供者可能不必要地为了改善他们的情况而开阿片类药物 患者体验指标以及参议员黛安·范斯坦 (Dianne Feinstein) 和查尔斯·格拉斯利 (Charles Grassley) 在 他们的信敦促 CMS 考虑、研究并解决基于患者满意度之间的联系 报销和阿片类药物处方，26 名参议员也在给国务卿的类似信中表达了这一观点 健康与人类服务。 CMS 承认在这个问题上缺乏严格的证据基础，这一点 最近，白宫阿片类药物委员会 2017 年 7 月的临时报告也呼应了这一点，该报告强调了 需要对患者满意度和疼痛程度作为标准进行彻底检查 评估和支付哪些提供商。拟议的研究将解决这一知识差距并提供 关于是否以及在多大程度上将医院报销与患者联系起来的一些初步经验证据 护理体验指标影响住院护理期间和出院后的阿片类药物处方，以及它如何影响 影响阿片类药物的长期使用。该项目将链接 Medicare A 部分索赔和 Medicare D 部分事件数据， 并利用 2012 年 10 月向大多数人引入 Medicare 的 HVBP 所提供的自然实验， 但并非所有医院都可以估计合理的因果影响。该项目还将利用消除疼痛的方法 从 2018 财年开始，HVBP 提出了管理问题，以进一步理清这些影响。与私人 医疗保险部门效仿医疗保险，在计算付款时给予患者护理体验更大的作用， 影响可以传播到医疗保险之外，拟议的研究对于理解具有更广泛的影响 将患者体验措施与付款激励挂钩的任何潜在的意外后果。