联邦资格医疗中心的替代支付模式和绩效
Justin Markowski1, Jacob Wallace1, Mark Schlesinger1
1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
JAMA internal medicine
|July 8, 2024
概括
为联邦合格医疗中心 (FQHC) 转向替代支付模式 (APM) 改善了癌症查和BMI评估等质量措施. 在医疗保健中,APM显示出有望实现经济可行和促进健康的医疗补偿.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
背景情况:
- 国家医疗补助机构正在从服务费转向联邦合格卫生中心 (FQHC) 的替代支付模式 (APM).
- 这种过渡对FQHC绩效的影响在很大程度上仍未知.
研究的目的:
- 评估APM与临床表现之间的关联,支付人组合,风险概况和FQHC的财务可持续性.
- 确定APM是否影响FQHC提供优质护理和管理患者人群的能力.
主要方法:
- 从2009年到2021年,对37个州和华盛顿特区的684个FQHC进行了回顾性队列研究.
- 使用统一数据系统和IRS表格990数据用于付款人组合,风险概况和财务信息.
- 采用差异差异设计,比较FQHC在APM实施之前和之后与没有APM的控制状态.
主要成果:
- 在APM州的FQHC显示结直肠癌查,成人BMI评估和儿童BMI评估显著增加.
- 在高血压和2型糖尿病控制中观察到适度的改善.
- 没有证据表明FQHC选择了更健康的患者或由于APM减少了护理强度.
结论:
- 医疗补助APM与FQHC中适度,统计学上显著的质量改善有关,特别是那些具有质量激励模型的FQHC.
- APM可以成为医疗保健安全网的经济可行和促进健康的报销策略.
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