基于价值的CMS医院计划:需要改进,以减少健康差异和改善结果
Charles N Kahn1, Kimberly Rhodes2, Sarmistha Pal3
1Charles N. Kahn III, Federation of American Hospitals, Washington, D.C.
Health affairs (Project Hope)
|July 5, 2023
概括
医疗保险和医疗补助服务中心 (CMS) 基于价值的计划可能会不公平地惩罚医院. 无法控制的因素,如患者的复杂性和社区需求,特别是在服务不足的地区,影响处罚,表明需要进行健康公平调整.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策分析 卫生政策分析
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 使用基于价值的计划来根据质量表现调整医院支付.
- 主要项目包括医院再录取减少计划,医院基于价值的采购计划和医院获得的条件减少计划.
- 这些计划旨在激励改善医疗保健服务和患者结果.
研究的目的:
- 分析三个主要的CMS医院计划的基于价值的程序惩罚结果.
- 评估患者和社区健康公平性风险因素对医院处罚的影响.
- 确定CMS程序是否充分考虑其惩罚结构中的健康公平性.
主要方法:
- 从CMS基于价值的程序中分析惩罚数据.
- 医院处罚与无法控制的因素之间的关系的统计评估.
- 包括医疗复杂性 (等级状况类别),无偿护理和社区特征 (例如,独自生活的人口).
主要成果:
- 在医院处罚和无法控制的因素之间发现了统计学上显著的积极关系:医疗复杂性,无偿护理和独自生活的人口.
- 这些环境因素不成比例地影响了为历史上服务不足的人口服务的医院.
- CMS计划可能无法充分考虑社区层面的健康公平风险因素.
结论:
- 目前的CMS基于价值的计划可能会根据无法控制的因素无意中惩罚医院.
- 卫生公平方面的考虑,特别是社区层面的因素,似乎没有得到充分的解决.
- 建议改进计划,包括明确的健康股权风险因素,以确保公平性和预期结果.
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