安全网医院在基于医院价值的采购-优先考虑满意度而不是结果的情况下得到公平的补偿吗?
概括
调整医院价值基础采购计划 (HVBP) 的权重可以改善安全网医院 (SNH) 的报销. 优先考虑临床结果和安全性是SNH经济上的好处.
科学领域:
- 医疗服务研究
- 医疗保健政策
- 医院管理
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 使用基于医院价值的购买计划 (HVBP) 偿还医院费用.
- 目前的HVBP权重在临床结果,安全性,效率和患者满意度之间均等分配价值.
- 在目前的HVBP结构下,安全网医院可能面临补偿不公平.
研究的目的:
- 调查修改HVBP权重是否可以解决SNH的补偿差异.
- 分析HVBP调整后对SNH财务业绩的影响.
主要方法:
- 根据2020年CMS支付数据分析了2,731家非联邦医院.
- 根据不成比例份额医院 (DSH) 的地位将医院分为SNH和非SNH.
- 在SNH和非SNH之间比较HVBP得分,考虑COVID-19的影响.
主要成果:
- 与非SNH相比,SNH在患者和社区参与领域的得分较低 (p<0. 001).
- 这导致HVBP总性能得分 (TPS) 和SNH调整系数显著降低 (p<0. 001).
- 将TPS重量重新分配以优先考虑临床结果和安全性 (35%) 提高了SNH的性能.
结论:
- 将HVBP重量转移到临床结果和安全方面可以减轻SNH的财务负担.
- 基于价值的采购政策的调整可以促进对弱势医院群体的公平补偿.
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