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临界门诊医院:从边境社区卫生整合项目中吸取教训
Melissa A Romaire1, Alison Banger1, Regina Rutledge1
1RTI International, Research Triangle Park, North Carolina, USA.
概括
边境社区卫生整合项目 (FCHIP) 旨在改善农村医疗保健服务. 虽然临界接入医院 (CAH) 增强了服务和伙伴关系,但付款变化对财务影响最小,缓和了基于数量的政策预期.
科学领域:
- 农村卫生政策 农村卫生政策
- 医疗保健管理的管理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 在2016年启动了边境社区健康整合项目 (FCHIP).
- FCHIP的目标是边境地区的关键接入医院 (CAH),为医疗保险的服务费患者提供服务.
- 该项目测试了医疗保险支付和政策变化对远程医疗,救护车和熟练护理设施 (SNF) 服务的影响.
研究的目的:
- 评估FCHIP倡议对CAH提供服务的影响.
- 评估FCHIP干预措施如何影响救护车,SNF和远程医疗利用.
- 了解参与FCHIP的CAH的实施经验.
主要方法:
- 这主要是对蒙大拿州,内华达州和北达科他州10个CAH的质量评估.
- 对关键信息人采访和计划文件进行主题分析,以了解干预实施.
- 对救护车,SNF和远程医疗服务的医疗保险服务费索赔 (2013年8月至2019年7月) 的描述性分析.
主要成果:
- CAH利用FCHIP发展其员工队伍并改善护理交付模式,尽管面临员工流动性挑战.
- 技术援助对于支持CAHs的护理转型至关重要.
- CAH工作人员报告FCHIP支付和政策变化的财务影响有限;服务使用因FCHIP服务而异.
结论:
- 医疗保健人员通过改善医疗服务来证明他们对社区需求的承诺,即使面临人员短缺等挑战.
- 基于体积的支付政策对CAH的财务效益可能是有限的,因为患者数量较低.
- 虽然FCHIP有助于改善护理提供和伙伴关系,但金融可持续性仍然是边境CAH的关注点.
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