Hospital-Physician Gainsharing

医院与医生利益共享

• 批准号: 7786162
• 负责人: Jonathan David Ketcham
• 金额: $ 27.26万
• 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 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7786162
• 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持续快速增长，但这笔支出的价值不确定。医生之间以及医院与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。在心脏病学和骨科手术等服务领域，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。一些付款人和提供者已经采用了基于团体的激励计划来改善一致性。目前，私营部门的医院以及医疗保险和医疗补助示范项目中心正在使用一种称为收益共享的方法。根据收益共享，如果成本相对于历史基线降低，医生团体将收到一笔必须在其成员之间平均分配的付款。 该项目的总体目标是通过改进医生激励计划的设计来提高医疗保健决策的价值。在初步工作中，我们发现 2006 年底之前实施的计划降低了成本，但没有减少可用的质量或准入措施。完整的理论模型为医院和医生如何在收益分享的激励下做出决策提供了见解。拟议的工作以这些结果为基础，以实现三个具体目标：1）确定收益分享是否会降低药品和设备的利用率和医院价格，以及如何实现降价； 2）确定收益共享是否促进医生治疗决策的协调和标准化； 3）展示医生对收益分享的反应有何不同。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（包括不同设计的收益共享计划）的反应。 为了实现这些目标，我们建议审查 2009 年底之前实施的所有私营部门心脏病学收益分享计划。这涵盖了 13 家医院的多达 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 2001 年至 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约 130 个其他非收益共享冠状动脉导管插入术实验室的同期数据。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，包括医院为其支付的价格。它们还包括比管理数据中提供的更详细的风险调整变量集。该项目分为三个主要步骤：我们通过实证检验理论模型的假设来确定医生对收益分享的反应；通过扩展和测试模型，我们发现了为什么医生对收益分享的反应有所不同；我们通过开发结构模型来量化医生如何权衡激励计划的各个方面。研究结果可以为监管机构、政策制定者和管理者在考虑通过协调促进价值的各种激励计划时提供及时的见解。