The Effect of Patient Dementia on Outpatient Clinicians' Performance on Cost Outcomes Under Medicare Value-Based Payment.

患者痴呆症对门诊临床医生在医疗保险基于价值的支付下的成本结果的影响。

• 批准号: 10054768
• 负责人: Kenton James Johnston
• 金额: $ 16.67万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10054768
• 关键词: Alzheimer' s disease related dementia; Categories; Cost Measures; Data; Dementia; Development; Diagnosis; Drug Prescriptions; Elderly; Funding; Goals; Health; Health system; Incentives; Individual; Link; Measures; Medical; Medicare; Medicare claim; Mission; Modeling; National Institute on Aging; Outcome; Outpatients; Patient Self-Report; Patient risk; Patient-Focused Outcomes; Patients; Performance; Physicians; Population; Prevalence; Provider; Public Health; Research; Residual state; Rest; Retrospective cohort study; Risk; Risk Adjustment; Risk Estimate; Sensitivity and Specificity; Surveys; System; Testing; Time; United States Centers for Medicare and Medicaid Services; base; beneficiary; care costs; cost; cost outcomes; data centers; dementia care; disparity reduction; evidence base; health care quality; high risk; improved; patient population; payment; programs; research study; systems research; virtual; web site

Project Summary The Medicare program is implementing value-based payment (VBP), in which outpatient clinicians are paid based on the quality and cost of the care they deliver. However, there is increasing concern these VBP programs may not accurately measure performance among clinicians who serve high-risk patient populations, particularly those with Alzheimer’s disease and related dementias (hereafter “dementia”). Prior research finds that dementia is independently associated with poorer patient outcomes and markedly higher costs of care. Furthermore, patients with dementia tend to be clustered among certain types of clinicians, such as geriatricians. However, although Medicare adjusts clinicians’ performance under VBP for the medical risk of their patients using the Centers for Medicare and Medicaid Services’ hierarchical condition category (CMS- HCC) risk model, it does not adjust for dementia. This could result in systematic under-estimation of performance for clinicians that disproportionately serve patients with dementia. Therefore, there is a critical need for research on the effect of patient dementia on measures of clinician performance under VBP, how this impacts providers who disproportionately serve such patients, and whether measures of dementia can be integrated into the CMS-HCC Medicare risk adjustment model. Our long-term goal is to incorporate measures of patient dementia into the risk adjustment system that Medicare uses in implementing VBP. The objectives of this R21 application are to: 1) validate the adequacy of claims-based measures of dementia; 2) evaluate the performance of a claims-based costs of care model that includes dementia by adding it to the standard CMS- HCC risk model; and 3) demonstrate the effects of our new model versus the standard CMS-HCC model on clinicians’ relative performance on cost measures in MIPS and the program more broadly. Our rationale for this project is that most clinicians in the U.S. will be held accountable for their performance on cost measures under VBP, and there is a significant risk that clinicians who disproportionately serve patients with dementia may be negatively impacted if these factors are not accounted for by risk adjustment. This research study will pursue three specific aims. For aim #1, we will conduct a retrospective cohort study using the Medicare Current Beneficiary Survey (MCBS) linked to prescription drug and claims data to validate the use of claims- based measures of dementia against patient self-report and prescription drug data. For aim #2, we will use the most recently available Medicare claims data from the CMS Virtual Research Data Center (VRDC) to identify the portion of Medicare costs attributable to dementia that are currently unexplained by the CMS-HCC risk model, and evaluate a model that improves prediction by adding risk points for dementia patients. For aim #3, we will use the CMS VRDC and Physician Compare data to assess the impact of claims-based risk adjustment for dementia on clinician performance on VBP cost outcomes, performance scores, and reimbursement, comparing clinicians who disproportionately serve patients with dementia to the rest of Medicare clinicians.

项目摘要 医疗保险计划正在实施基于价值的支付(VBP)，即向门诊临床医生支付费用 基于他们提供的护理的质量和成本。然而，人们越来越担心这些越南船民 计划可能无法准确衡量为高危患者群体提供服务的临床医生的表现， 尤其是那些患有阿尔茨海默氏症和相关痴呆症(以下简称“痴呆症”)的人。先前的研究发现 痴呆症与较差的患者结局和明显较高的护理成本独立相关。 此外，痴呆症患者往往集中在某些类型的临床医生中，例如 老年病医生。然而，尽管联邦医疗保险在VBP下调整了临床医生的表现，以应对 他们的患者使用医疗保险和医疗补助服务中心的分级病情类别(CMS- 肝癌)风险模型，它不会针对痴呆症进行调整。这可能会导致系统性低估 为痴呆症患者提供不成比例服务的临床医生的表现。因此，有一个关键的 需要研究痴呆症患者对VBP下临床医生表现的影响，这是如何实现的 影响不成比例地为此类患者提供服务的提供者，以及痴呆症的衡量标准是否可以 整合到CMS-HCC医疗保险风险调整模型中。我们的长期目标是将各项措施 将患者痴呆症的风险调整系统纳入医疗保险在实施VBP时使用的风险调整系统。的目标 此R21应用程序用于：1)验证基于声明的痴呆症测量方法的充分性；2)评估 将痴呆症纳入标准CMS的基于索赔的护理费用模型的执行情况- 和3)展示了我们的新模型与标准的CMS-HCC模型相比对 临床医生在MIPS和更广泛的计划中在成本衡量方面的相对表现。我们这样做的理由是 项目是，美国的大多数临床医生将对他们在成本衡量方面的表现负责 在VBP下，有一个显著的风险，即不成比例地为痴呆症患者服务的临床医生 如果这些因素没有被风险调整考虑在内，可能会受到负面影响。这项研究研究将 追求三个具体目标。对于目标1，我们将使用Medicare进行一项回溯性队列研究 与处方药和索赔数据相关联的当前受益人调查(MCBS)，以验证索赔的使用- 根据患者自我报告和处方药数据对痴呆症的测量。对于目标2，我们将使用 来自CMS虚拟研究数据中心(VRDC)的最新可用的Medicare索赔数据，以确定 医疗保险费用中可归因于痴呆症的部分，目前无法通过CMS-HCC风险来解释 模型，并评估一个通过增加痴呆症患者的风险点来改进预测的模型。对于目标3， 我们将使用CMS VRDC和医生比较数据来评估基于索赔的风险调整的影响 对于痴呆症患者，临床医生在VBP成本结果、绩效评分和报销方面的表现， 将为痴呆症患者提供不成比例服务的临床医生与其他医疗保险临床医生进行比较。