在关节置换手术的机构开支中,参与一个捆绑支付模式的技术护理机构
Michael L Barnett1,2, Karen E Joynt Maddox3,4, E John Orav1,2
1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA
|November 10, 2020
概括
改善护理的捆绑支付 (BPCI) 模式3将下肢关节置换患者的医疗保险支出降低了5.6%. 这种支付模式没有显著影响死亡率或再录取率.
科学领域:
- 健康经济学
- 医疗保健政策
- 年长者护理
背景情况:
- 熟练护理机构 (SNF) 参与医疗保险的护理改善捆绑支付 (BPCI) 模式3,承担SNF后患者支出的财务责任.
- 关于这种创新的支付策略的结果的证据有限.
研究的目的:
- 评估BPCI模型3对接受下肢关节置换 (LEJR) 的医疗保险受益人的医疗保健支出,利用和患者结果的影响.
主要方法:
- 通过使用2013年至2017年的医疗保险索赔数据进行了观察性差异分析.
- 在BPCI模型3中,80648名LEJR患者的SNF与倾向性比分匹配的对照SNF进行了比较.
- 该研究评估了机构支出,病例组合,入院量,家庭医疗使用,住院时间和90天内的住院使用.
主要成果:
- 与对照组相比,BPCI SNF的机构支出下降了5.6%,每次减少了1008美元.
- 这一支出减少主要是由于每位受益人SNF日数减少.
- 没有观察到患者死亡率或90天再入院的显著变化.
结论:
- BPCI模型3与Medicare LEJR患者的机构支出显著下降有关.
- 需要对不同临床环境中的捆绑支付模式进行进一步的研究.
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