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基本组成部分。 2015年4月16日，2015年《联邦医疗保险接入和芯片再授权法案》(MACRA) 签署成为法律。《马卡条约》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制度。在……里面 代替SGR，Medicare将通过以下两种质量之一向医疗保健提供者支付费用 支付计划：基于功绩的奖励支付系统(MIPS)或高级 到2019年的替代支付模式(APM)。这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 由联邦医疗保险报销，以解决其实践中基于结果的指标。实践 需要确定如何最好地激励他们的供应商实现成果衡量标准 由医生质量报告系统(PQRS)提供，同时保持高质量 以病人为中心的关怀。要成功地实施一个 基于结果的支付方案：(I)不清楚新的货币激励措施如何相互作用 提供商行为的基本驱动因素；以及(Ii)很难确定 适当的结果来激励。对这些障碍的洞察将在 告知初级保健提供者如何最好地适应报销方面的变化。这个 本研究的重点是一个。)初级保健的不同筹资模式如何影响 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。这件事的意义 研究有三个方面：第一，我们将更好地了解 货币激励和行为，这是实施成果的关键组成部分- 基于支付；其次，我们将利用医疗保健模拟来隔离和 测试金融改革对提供者行为的影响；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来提供医疗服务。这项研究的结果将提供证据 需要确保医疗政策促进旨在使 负担得起的医疗保健继续提高患者的安全和质量护理，从而， 公共卫生。

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 Title I of MARCA repealed the sustainable growth rate formula (SGR), the system in which Medicare reimbursement fees have been determined since 1997.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.