A Simulation Study of the Medicare Access and Chip Reauthorization Act

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。4月16日， 2015年，《2015年医疗保险准入和芯片再授权法案》（MACRA）签署成为法律。第一编 MARCA废除了可持续增长率公式（SGR），该系统中，医疗保险 自1997年以来一直确定偿还费用。在SGR的地方，医疗保险将支付健康 护理提供者通过两个质量支付计划之一：基于绩效的奖励支付 在2019年之前，我们可以使用MIPS系统或高级替代支付模式（APM）。两种质量支付 计划将提供者的付款与绩效挂钩，这将迫使获得报销的医疗保健提供者 通过医疗保险解决其实践中基于结果的指标。实践将需要确定 如何最好地激励他们的提供者实现医生质量提供的结果指标 报告系统（PQRS），同时保持高质量的以患者为中心的护理。有两个潜在的 实施成功的基于结果的支付计划的障碍：（一）不清楚新的 货币激励与供应商行为的基本驱动因素相互作用;（ii）很难 确定适当的激励结果。对这些障碍的深入了解将有助于 初级保健提供者如何最好地适应报销的变化。本研究的重点是a）。 不同的初级保健筹资模式如何影响高质量保健的提供;以及B.）如何 初级保健的不同外部支持、提供或融资模式可改善患者和/或提供者的 满意这项研究的意义是三重的：第一，我们将提供一个更好的了解， 货币激励和行为之间的相互作用，这是实施 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，我们将建立和基础设施，以测试 适当的结果，以激励是关键，以提高护理质量，通过基于结果的 支付这项研究的结果将产生必要的证据，以确保医疗保健政策促进 支付模式旨在使医疗保健负担得起，并继续提高患者的安全性， 高质量的医疗服务，从而保障公众健康。

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 Title I of MARCA repealed the sustainable growth rate formula (SGR), the system in which Medicare reimbursement fees have been determined since 1997.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 and continue to increase patient safety and quality care and thereby, public health.