Financial Incentives, Treatment of Medicare Patients with Spine Problems and Chan

描述(申请人提供)：背部/脊柱问题非常常见，约30%的45岁以上的人受到影响。尽管发病率在近30年来一直保持稳定，但脊柱手术、注射、先进成像和物理疗法治疗背部/脊柱疾病的比率显著增加，这表明背部/脊柱问题的治疗已变得更加资源密集型。此外，脊柱外科有相当大的地域差异，这似乎没有临床或科学证据证明是合理的。可能的解释包括缺乏明确的实践指南，进行更多手术的财政激励，以及临床培训方面的差异。没有研究调查更多的资源密集型治疗和更高的支出，无论是随着时间的推移还是跨地区的支出，是否会导致更好的患者结果。鉴于联邦医疗保险受益人人数和支出的预期增长，评估联邦医疗保险在背部/脊柱问题上的支出效率至关重要。这个项目提出了两个研究问题。第一个问题是，与医生拥有专科医院或门诊手术中心(ASC)相关的财务激励是否会影响患有背部/脊柱疾病的联邦医疗保险受益人的护理模式。具体地说，由在专科医院或ASC有明显经济利益的医生治疗的联邦医疗保险背部/脊柱患者是否比其他联邦医疗保险背部/脊柱患者的支出更高？其次，如果这些医疗保险患者确实接受了更密集的背部/脊柱问题治疗，在控制基线健康状况和其他社会人口学特征的情况下，他们的健康结果是否更好？该项目将使用与2002年至2007年的联邦医疗保险索赔数据相关联的联邦医疗保险当前受益人调查来审查这些重要的政策问题。该分析将比较联邦医疗保险受益人与由三种类型的提供者治疗的背部/脊柱问题：1)在专科医院或ASC有经济利益(关系)的医生；2)受雇于医院或卫生系统的医生；以及3)与专科医院或ASC没有直接经济关系的医生。 公共卫生相关性：这些发现将为一个关键的卫生政策问题提供新的见解--更大的资源密集度是否与健康和整体功能的改善有关。结果将表明，财政激励是否会导致每个受益者的支出增加，如果是这样，这种支出是否代表低效率、成本超过收益，或代表医疗支出的权衡。这些信息将对政府和私人付款人、雇主和消费者具有重要价值，他们担心医疗保健支出和保险费不断上升。此外，这些信息将与正在进行的关于如何控制医疗保险和其他医疗保健支出的辩论高度相关。

DESCRIPTION (provided by applicant): Back/spine problems are extremely common, affecting about 30% of persons over age 45. Although prevalence has remained steady for nearly three decades, rates of spinal surgery, injections, advanced imaging and physical therapy to treat back/spine disorders have increased significantly, suggesting that treatment of back/spine problems has become more resource intensive. Moreover, there is considerable geographic variation in spinal surgery, which does not appear to be justified by clinical or scientific evidence. Possible explanations include lack of clear practice guidelines, financial incentives to perform more surgery and differences in clinical training. No studies investigate whether more resource intensive treatments and higher spending, either over time or across areas, result in better patient outcomes. Given the expected growth in the number of Medicare beneficiaries and expenditures, it is critical to evaluate the efficiency of Medicare's spending for back/spine problems. This project poses two research questions. The first addresses whether financial incentives linked to physician ownership of either specialty hospitals or ambulatory surgery centers (ASCs) affect patterns of care for Medicare beneficiaries with back/spine disorders. Specifically, do Medicare back/spine patients treated by physicians with an apparent financial interest in specialty hospitals or ASCs have higher expenditures than other Medicare back/spine patients? Second, if these Medicare patients do receive more intensive treatment for their back/spine problems, do they have better health outcomes, controlling for baseline health status and other sociodemographic characteristics? The project will examine these significant policy questions using the Medicare Current Beneficiary Surveys linked to Medicare claims data spanning the years 2002- 2007. The analysis will compare Medicare beneficiaries with back/spine problems treated by three types of providers: 1) physicians with financial interests (relationships) in specialty hospitals or ASCs; 2) physicians who are employed by a hospital or health system; and 3) physicians who have no direct financial relationship with a specialty hospital or ASC. PUBLIC HEALTH RELEVANCE: The findings will provide new insights on a critical health policy issue-whether greater resource intensity is associated with improvements in health and overall functioning. The results will indicate whether financial incentives result in higher spending per beneficiary and if so, whether such expenditures represent inefficiency, where the costs exceed the benefits, or represent a health-spending tradeoff. Such information will be of significant value to government and private payers, employers and consumers who are concerned about escalating health care spending and insurance premiums. Moreover, such information will be highly relevant regarding the ongoing debate over how to control Medicare and other health care spending.