2020年CMS对医院门诊部门的事先授权:相关的外科手术体积影响
Joseph N Fahmy1, Trista M Benítez2, Zhongzhe Ouyang3
1Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI. Electronic address: https://twitter.com/jfahmyMD.
Surgery
|August 10, 2024
概括
美国医疗保险和医疗补助服务中心 (CMS) 的政策CMS-1717-FC并没有显著改变医院门诊部门的外科手术手术量. 这种事先授权政策并没有改变医疗保险费用服务受益人的护理利用现有趋势.
科学领域:
- 卫生政策 卫生政策
- 外科手术的结果
- 医疗保健利用情况 医疗保健利用情况
背景情况:
- 在医疗保险优势计划中,事先授权是常见的,但在公共计划中,外科护理并不典型.
- 2020年医疗保险和医疗补助服务中心 (CMS) 政策 (CMS-1717-FC) 要求医疗保险服务费受益人在医院门诊部门进行特定程序的事先授权.
- 该政策对外科手术量和护理转移到门诊手术中心的影响以前是未知的.
研究的目的:
- 评估CMS政策CMS-1717-FC对医院门诊部门外科手术程序量的影响.
- 评估该政策是否导致护理服务转移到门诊外科中心.
主要方法:
- 追溯性队列研究,利用来自医疗保健成本和利用项目的国家数据库 (门诊外科和住院患者) 的数据.
- 采用分段中断时间序列和前后后物流回归模型来分析政策实施前后的趋势.
- 检查了从2016年到2021年的数据,包括272,879例患者手术.
主要成果:
- 在政策制定前,医疗保险收费服务受益人使用医院门诊部门的下降趋势被观察到 (每年10.82%).
- 在政策实施后,没有发现这种下降趋势有显著变化 (-3.45%/年).
- 在政策制定之前,受益者不太可能使用独立的 (46%) 和医院拥有的 (27%) 门诊外科中心.
结论:
- 根据CMS-1717-FC的政策,医院门诊病房的外科手术数量并没有超过之前的趋势,但在统计学上没有显著变化.
- 未来的政策应该考虑程序类型和服务地点,以平衡医疗必要性和成本控制.
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