参与MIPS和ACOs的初级保健临床医生使用预防服务的差异
Mina Shrestha1, Hari Sharma, Keith J Mueller
1Author Affiliations: Department of Health Management and Policy, The University of Iowa College of Public Health, Iowa City, Iowa.
Quality management in health care
|November 5, 2024
概括
与基于功绩的激励支付系统 (MIPS) 的临床医生相比,负责护理组织 (ACO) 的临床医生显示了更高的肺炎疫苗接种率和健康访问,但较低的结肠直肠癌查率. 政策制定者应该调整激励措施,以确保全面的质量测量改进.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保健政策 医疗保健政策
- 预防医学 预防医学
背景情况:
- 基于价值的支付计划通过将提供者支付与成本和质量联系起来,激励高价值的护理.
- 医疗保险和医疗补助服务中心 (CMS) 在2017年实施了质量支付计划 (QPP).
- 根据QPP的临床医生参与先进的替代支付模式 (A-APM),如可问责的护理组织 (ACO) 或基于优点的激励支付系统 (MIPS).
研究的目的:
- 评估MIPS和ACO的初级保健临床医生之间预防性服务利用的差异.
- 了解QPP参与模式如何影响各种质量措施的采用.
- 为基于绩效的支付计划的政策调整提供信息.
主要方法:
- 用差异回归来比较预防性服务费率.
- 作为治疗组,ACO临床医生作为治疗组,非ACO MIPS临床医生作为比较组.
- 从2012年至2018年分析了流感免疫接种,肺炎疫苗接种,戒烟,抑郁症查,结肠直肠癌,乳腺癌查和健康检查的数据.
主要成果:
- 与MIPS临床医生相比,ACO临床医生的肺炎疫苗接种率 (IRR 1.25) 和结直肠癌查率 (IRR 0.69) 显著更高.
- 在ACO共享仅储蓄模型中的临床医生显示肺炎疫苗接种率更高 (IRR 1.28),抑郁症查率更高 (IRR 1.72) 和健康访问率更高 (IRR 1.27).
- 在ACO和MIPS临床医生之间的乳腺癌查或戒烟干预措施中没有发现显著差异.
结论:
- ACO临床医生可能会优先考虑低成本的服务,如肺炎疫苗接种和健康访问,以提高QPP的性能.
- 该研究表明,政策制定者需要在基于绩效的支付计划中改进激励措施.
- 调整是必要的,以确保在所有临床医生群体中全面改善质量措施,包括癌症查.
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