价值之路不能用一个破碎的医疗保险医生费用表铺平
Robert A Berenson1, Kevin J Hayes2
1Robert A. Berenson (RBerenson@urban.org), Urban Institute, Washington, D.C.
Health affairs (Project Hope)
|July 1, 2024
概括
基于价值的支付和医疗保险费用表是互补的,而不是单独的. 基于价值的支付成功,改革费用表是必不可少的,解决错误估值的服务和整合新的支付模式.
科学领域:
- 卫生政策 卫生政策
- 医疗保健经济学 医疗经济学
- 支付改革是为了改革支付方式.
背景情况:
- 基于价值的支付模式旨在提高医疗保健质量和控制成本.
- 医疗保险医生费用表 (MPFS) 是一种收费服务模式,从历史上来看,它与其他支付模式是分开的.
- 在MPFS中的缺陷可能会阻碍基于价值的支付倡议的有效性.
研究的目的:
- 为了证明基于价值的支付和MPFS的互补性质.
- 识别和分析MPFS固有的缺陷,阻碍基于价值的护理.
- 为成功实施基于价值的支付策略提出必要的改革建议.
主要方法:
- 分析MPFS的历史发展和当前结构.
- 审查MPFS内部的支付扭曲,包括对程序/成像的高估和对初级保健的低估.
- 评估MPFS整合捆绑和基于人口的支付能力.
主要成果:
- 在MPFS中存在严重的支付扭曲,破坏了基于价值的护理原则.
- 某些服务,如手术和成像,被高估了,而其他服务,如初级保健,被低估了.
- 可以调整MPFS结构以纳入捆绑和基于人口的支付元素.
结论:
- 医疗保险和医疗补助服务中心 (CMS) 必须纠正错误估值的服务,并实施初级保健的混合支付模式.
- 需要对医疗保险费用设定法定基础进行国会改革,以便CMS能够考虑工作人员短缺等政策优先事项.
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