在医疗保险基于价值的支付模式中临床医师参与的变化,2017年至22年
Alexander O Everhart1, Peter F Lyu2, Karen E Joynt Maddox3
1Alexander O. Everhart (everhart@wustl.edu), Washington University in St. Louis, St. Louis, Missouri.
Health affairs (Project Hope)
|August 4, 2025
概括
医疗保险和医疗补助服务中心 (CMS) 质量支付计划 (QPP) 增加了临床医生的免除基于价值的模型. 这一趋势可能会阻碍通过负责任的护理倡议改善人口健康.
科学领域:
- 卫生政策 卫生政策
- 医疗保健经济学 医疗保健经济学
- 医疗实践管理 医疗实践管理
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 正在将医疗保险受益人转向以价值为基础的护理.
- 质量支付计划 (QPP) 鼓励临床医生参与替代支付模式.
- 了解临床医生参与趋势对于评估基于价值的护理计划的成功至关重要.
研究的目的:
- 分析从2017年到2022年的各种QPP支付模式中临床医生参与的变化.
- 确定临床医生免除基于价值的支付模式的趋势.
- 评估这些趋势对人口健康结果的潜在影响.
主要方法:
- 构建了一组临床医生在2017年至2022年之间收费B部分服务的纵向队列.
- 临床医师的参与被分类为不同的QPP模型,包括基于优点的激励支付系统 (MIPS) 和负责任的护理组织 (ACO).
- 参与或豁免基于价值的模型的临床医生比例为每一年计算.
主要成果:
- 免除QPP的临床医生的百分比从2017年的27.5%增加到2022年的38.1%.
- 参与传统MIPS模型的比例大幅下降,而参与双面ACO则增加.
- 参与单边的ACO减少,参与其他替代支付模式 (APM) 略有增加.
结论:
- 越来越多的临床医生不参与基于价值的支付模式.
- 这种趋势给CMS带来了潜在的挑战,即通过负责任的护理来实现人口层面的健康改善.
- 可能需要进一步的策略来鼓励更广泛的临床医生参与以价值为基础的护理.
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