发病率,持久性和稳定状态的流行在编码强度的健康计划支付的健康计划支付
Thomas G McGuire1, Oana M Enache2, Michael Chernew1
1Department of Healthcare Policy, Harvard Medical School, Boston, MA.
概括
医疗保险诊断编码强度可以通过发生率和持久性来衡量. 这些指标解释了日益增长的流行率,并为对风险调整的编码实践的监测提供了信息.
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
- 流行病学 流行病学
背景情况:
- 医疗保险中的诊断编码强度会影响风险调整和支付模式.
- 了解编码动态对于准确的医疗保健政策和财务评估至关重要.
- 之前的测量没有完全捕捉到编码流行变化的时间方面.
研究的目的:
- 定义医疗保险诊断编码强度的新措施.
- 为了捕捉随着时间的推移编码流行变化的动态.
- 将这些措施应用于医疗保险对负责任护理组织 (ACO) 风险调整模型中的高成本诊断.
主要方法:
- 对2017-2018年医疗保险索赔数据的回顾性分析.
- 使用了20%的随机抽样分配给ACO的受益人.
- 将编码的流行情况分解为发病率 (新编码) 和持久性 (继续编码).
主要成果:
- 引入了"稳定状态流行率",作为基于当前发病率和持续率的假设长期流行率.
- 证明了发病率和持续性如何解释编码流行率的观察到的增长.
- 在Medicare的ACO风险调整模型中说明了这些措施对昂贵诊断的应用.
结论:
- 诊断编码行为是异质的,并响应激励.
- 单独测量发病率和持续性可以加强对编码实践的监测.
- 编码实践的变化可能对患病率产生长期影响,独立于正在进行的行为转变.
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