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Las diferencias de gasto asociadas con la demostración de práctica del grupo de médicos de Medicare
Carrie H Colla1, David E Wennberg, Ellen Meara
1Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 35 Centerra Pkwy, Lebanon, NH 03766, USA. Carrie.H.Colla@Dartmouth.edu
JAMA
|September 13, 2012
Resumen
La demostración de la práctica de grupo de médicos de Medicare (PGPD) mostró un modesto ahorro de costos generales, con ahorros significativos concentrados en los beneficiarios elegibles para Medicare y Medicaid. Algunos grupos de médicos participantes lograron ahorros sustanciales, mientras que otros no lo lograron.
Área de la Ciencia:
- Economía de la salud Economía de la salud
- Política de la atención de la salud Política de salud.
- Mejora de la calidad en la atención médica.
Sus antecedentes:
- Los Centros de Servicios de Medicare y Medicaid (CMS) introdujeron los programas de la Organización de Cuidado Responsable (ACO) para mejorar la calidad de la atención médica y administrar los costos.
- La demostración de práctica de grupo de médicos de Medicare (PGPD) piloto precedió a las ACO, ofreciendo incentivos financieros para que los grupos de médicos cumplan con los objetivos de calidad y reduzcan los costos.
- Si bien la PGPD demostró mejoras de calidad, su impacto en los costos de atención médica seguía siendo incierto.
Objetivo del estudio:
- Para determinar el ahorro de costos global del PGPD.
- Estimar específicamente el ahorro de costos para los beneficiarios con doble elegibilidad para Medicare y Medicaid.
Principales métodos:
- Se empleó un diseño casi experimental, comparando las tendencias de gasto antes de la intervención (2001-2004) y después de la intervención (2005-2009).
- El grupo de intervención incluyó a 990.177 beneficiarios de Medicare de pago por servicio tratados por médicos PGPD; el grupo de control comprendió a 7.514.453 beneficiarios de las mismas regiones.
- El gasto anual por beneficiario fue la medida de resultado principal, con varios métodos de ajuste de riesgo utilizados para el análisis de casos mixtos.
Principales resultados:
- Los ahorros anuales totales por beneficiario fueron modestos (media ajustada de 114 dólares).
- Se observaron ahorros significativos para los beneficiarios doblemente elegibles (media ajustada de $ 532), pero no para los beneficiarios no doblemente elegibles.
- Las reducciones de gastos fueron principalmente en la atención aguda, con una notable variación en los ahorros entre los grupos de médicos participantes.
Conclusiones:
- El PGPD logró ahorros sustanciales en algunas instituciones, pero esto fue compensado por la falta de ahorros en otras.
- La mayoría de los ahorros de costos se realizaron entre los beneficiarios doblemente elegibles para Medicare y Medicaid.
- Los hallazgos destacan el impacto heterogéneo de los modelos de pago basados en la práctica en los gastos de atención médica.
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