医疗保险 ACO 的医院参与: 没有改变入院做法和支出
Amber K Sabbatini1, David B Muhlestein, Canada Parrish
1University of Washington, Magnuson Health Sciences Building, 1705 NE Pacific St, Box 357235, Seattle, WA 98195.
The American journal of managed care
|August 20, 2025
概括
医院参与负责任的护理组织 (ACO) 并没有改变急诊室的入院率,住院时间或计划外入院的费用. 这些发现表明对减少紧急护理支出的影响有限.
科学领域:
- 健康经济学
- 医疗保健政策
- 提高质量
背景情况:
- 负责任的护理组织 (ACOs) 是一个关键的医疗保险替代支付模式,旨在提高护理质量和降低成本.
- 尽管参与度不断增长,但ACO对医院运营实践和计划外入院费用的影响的证据仍然不尽相同.
研究的目的:
- 调查医疗保险 ACO 与急诊室 (ED) 入院实践的变化之间的联系.
- 研究ACO参与对非计划住院时间 (LOS) 的影响.
- 评估ACO对指数ED事件的总医疗支出的影响.
主要方法:
- 使用2008年至2019年的医疗保险费用索赔数据进行了差异分析.
- 在2012年至2017年期间加入医疗保险ACO的医院被确定并跟踪长达5年.
- 关键结果包括ED入院率,观察住院率,紧急入院的LOS和指数ED事件的总成本.
主要成果:
- 最长5年参与ACO的患者在ED住院率没有显著变化.
- 在参与的医院中,未计划入院的LOS没有显著变化.
- 加入ACO的医院和没有加入ACO的医院之间,指数ED事件的总成本没有显著差异.
结论:
- 医院主导的ACO参与并没有对计划外住院患者的护理提供带来重大变化.
- 这些发现表明,医院的 ACO 可能对降低与紧急住院相关的成本产生有限的影响.
- 这项研究引起了人们对当前由医院主导的ACO模式能够推动医疗服务的实质性转型和计划外入院的成本降低的担忧.
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