医生在基于功绩的激励支付系统中的表现:对健康差异的影响
Joseph H Joo1,2, Jubi Yl Lin3, Lingmei Zhou3
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
The Permanente journal
|July 16, 2025
概括
基于功绩的激励支付系统 (MIPS) 可能会加剧健康差异. 服务于低收入人群的实践,以医疗保险/医疗补助双重资格表示,获得较低的MIPS分数,风险不平等的护理.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
- 健康差异 在健康上的差异
背景情况:
- 基于功绩的激励支付系统 (MIPS) 旨在提高医疗保健的质量.
- 人们担心MIPS可能会使资源较少的实践处于不利地位,可能会扩大健康差距.
- 有限的研究已经探索了群体实践特征如何影响MIPS得分和退款.
研究的目的:
- 调查集团实践特征与基于功绩的激励支付系统 (MIPS) 评分之间的关联.
- 确定导致MIPS性能在不同实践类型和患者群体之间变化的因素.
主要方法:
- 使用了MIPS整体临床医生绩效数据库用于2019年MIPS绩效数据.
- 整合MIPS数据与来自达特斯地图等来源的医生团体实践特征信息.
- 包括来自县级健康排名文件的实践和区域级变量进行全面分析.
主要成果:
- 城市位置和较大的患者人群与更高的MIPS得分有积极的关联.
- 较高的患者人群病例组合和更高比例的医疗保险/医疗补助双重资格患者与较低的MIPS分数有关.
- 社区因素,如大学教育水平和医疗保健支出,也与MIPS绩效有关.
结论:
- 医疗保险/医疗补助双重资格患者的比例,作为社会经济地位的代理,与较低的MIPS分数有关,突出显示了潜在的差异.
- MIPS的表现受到各种实践和社区层面的因素的影响,包括健康的社会驱动因素.
- 决策者应该考虑调整MIPS评估以考虑实践特征,以减轻健康差异并确保公平的报销.
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