将医疗保险优惠入院纳入CMS医院范围内的再接收措施
Kelly Kyanko1, Kashika M Sahay2,3, Yongfei Wang2,3
1Department of Population Health, New York University Grossman School of Medicine, New York.
JAMA network open
|June 3, 2024
概括
包括医疗保险优势 (MA) 数据在医院再接收措施中提高了可靠性,并影响了医院绩效排名. 这一变化影响了三分之一的医院,特别是那些有更多阿尔茨海默病患者的医院.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善医疗保健质量 改善医疗保健质量
- 公共卫生政策 公共卫生政策
背景情况:
- 医疗保险优势 (MA) 注册人数正在增加,但传统的医疗保险和医疗补助服务中心 (CMS) 医院结果措施排除了MA受益人.
- 这种排除限制了医疗保险人口中越来越多的人群对医院绩效和质量的全面评估.
研究的目的:
- 评估将医疗保险优势 (MA) 索赔数据纳入CMS全医院全因计划外再接收 (HWR) 措施的影响.
- 在包括MA入院后,评估衡量可靠性,风险标准化再入院率和医院绩效排名的变化.
主要方法:
- 一项队列研究分析了2018年7月至2019年6月的医疗保险受益人的住院行政索赔数据.
- 在MA和Fee-for-Service (FFS) 之间比较再接收率和风险调整变量.
- 计算了FFS-only和FFS/MA联合队列的测量可靠性和风险标准化再接收率.
- 在添加MA入院后,评估了医院绩效五分位数排名的变化.
主要成果:
- 该研究包括超过1100万个入院申请,其中37%来自MA受益者.
- 随着MA数据的纳入,测试复试可靠性 (0.78对0.73) 和信号对噪声的可靠性得到了改善.
- 仅FFS和组合队列之间的平均医院风险标准化再入院率仍然相似 (15.5%vs15.3%).
- 三分之一 (33.1%) 的医院在他们的绩效五分位数排名中经历了变化,MA入学率较高的医院的变化更大.
结论:
- 将MA录取纳入HWR措施可以提高可靠性和精度.
- 包含MA数据允许对医院绩效进行更全面的评估,覆盖更多的受益人.
- 医院的绩效排名受到MA数据的显著影响,特别是为服务于更大MA人口的设施.
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