A Simulation Study of the Medicare Access and Chip Reauthorization Act

医疗保险准入和芯片再授权法案的模拟研究

• 批准号: 10001419
• 负责人: Ellen P Green
• 金额: $ 40.14万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10001419
• 关键词: Address; Adherence; Affect; Beds; Behavior; Caring; Client satisfaction; Clinical; Conflict (Psychology); Data; Disease; Ensure; Environment; Ethics; Event; Fees; Financial compensation; Foundations; Goals; Growth; Health Personnel; Health Policy; Healthcare; Incentives; Income; Infrastructure; Insurance Carriers; Laws; Lead; Link; Measurement; Measures; Medical Errors; Medicare; Methods; Modeling; Outcome; Outcome Measure; Patient-Centered Care; Patients; Performance; Physicians; Policies; Primary Health Care; Provider; Public Health; Quality of Care; Reporting; Research Methodology; Research Personnel; Safety; Service delivery model; System; Testing; Validation; base; care providers; collaborative care; cost; design; evidence base; experimental study; financial incentive; health care service organization; improved; insight; model design; novel; patient safety; payment; primary care setting; programs; satisfaction; simulation; success; tool

Project Summary New financing models are a fundamental component of current changes to primary care. On April 16th, 2015 the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law. Title I of MARCA repealed the sustainable growth rate formula (SGR), the system in which Medicare reimbursement fees have been determined since 1997. In the place of the SGR, Medicare will pay health care providers through one of two Quality Payment Programs: The Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APMs) by 2019. Both of the Quality Payment Programs link provider payment to performance, which will force healthcare providers who are reimbursed by Medicare to address outcome-based metrics within their practices. Practices will need to determine how to best motivate their providers to achieve outcome measures provided by the Physician Quality Reporting System (PQRS), while maintaining high quality patient centered care. There are two underlying barriers with implementing a successful outcome-based payment program: (i) it is unclear how new monetary incentives interact with the fundamental drivers of provider behavior; and (ii) it is difficult to ascertain the appropriate outcomes to incentivize. Insights into these barriers will be valuable in informing primary care providers how to best adapt the changes in reimbursement. The focus of this study is on a.) how different financing models for primary care affect the delivery of high quality care; and b.) how different external supports, delivery or financing models of primary care improve patient and/or provider satisfaction. The significance of this study is triple-fold: First, we will provide a better understanding of the interaction between monetary incentives and behavior, which is a key component of implementing outcome- based payment; secondly, we will leverage the use health care simulations to isolate and test the impact of finance reform on provider behavior; and lastly, we will build and infrastructure to test the appropriate outcomes to incentivize is pivotal to improving quality of care through outcome-based payment. The results of this study will produce evidence needed to ensure healthcare policy promotes payment models designed to make healthcare affordable continue to increase patient safety and quality care and thereby, public health.

项目摘要 新的筹资模式是当前初级保健改革的一个基本组成部分。 2015年4月16日，《2015年医疗保险获取和芯片再授权法案》（MACRA） 被签署成为法律。MARCA第一章废除了可持续增长率公式（SGR）， 自1997年以来确定医疗保险报销费用的系统。在 在SGR的地方，医疗保险将通过两个质量之一来支付医疗保健提供者 支付计划：基于绩效的激励支付系统（MIPS）或高级 到2019年实现替代支付模式（APM）。两个质量付款计划链接 提供者按绩效付费，这将迫使医疗保健提供者 由医疗保险报销，以解决其实践中基于结果的指标。做法 将需要确定如何最好地激励他们的供应商实现成果的措施 由医师质量报告系统（PQRS）提供，同时保持高质量 以病人为中心的护理。要实现一个成功的 基于结果的支付方案：（一）新的货币激励措施如何相互作用尚不清楚 与供应商行为的基本驱动因素;（ii）很难确定 适当的结果来激励。深入了解这些障碍将是有价值的， 告知初级保健提供者如何最好地适应报销的变化。的 本研究的重点是a）。不同的初级保健融资模式如何影响 提供高质量的护理;以及B.）不同的外部支持、交付或融资 初级保健模式提高了患者和/或提供者的满意度。其意义 研究是三重的：首先，我们将提供一个更好的理解之间的相互作用 货币激励和行为，这是实现成果的关键组成部分， 其次，我们将利用医疗保健模拟来隔离和 测试金融改革对供应商行为的影响;最后，我们将建立和 测试适当结果以激励的基础设施是提高质量的关键 通过基于结果的支付。这项研究的结果将提供证据 需要确保医疗保健政策促进支付模式， 负担得起医疗保健继续提高患者安全性和护理质量， 公共卫生