对比高级实践专业人员的临床工作,他们在负责任的护理组织内外工作
Hannah T Neprash1, John F Mulcahy2
1Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN.
Medical care
|September 30, 2025
概括
问责护理组织 (ACO) 并没有显著改变高级实践专业人员 (APP) 的实践或账单,这表明与非ACO相比,ACO内部的APP工作人员的部署成本意识有限.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保健管理的管理
- 先进的实践专业人士的专业人员.
背景情况:
- 医疗保健组织越来越多地利用先进实践专业人员 (APP) 并参与诸如问责护理组织 (ACO) 等替代支付模式.
- 与非ACO实践相比,ACO激励成本控制,可能会对APP实践模式产生不同的影响.
研究的目的:
- 为了比较APP和参与ACO的实践中的医生与不参与ACO的实践中的医生提供门诊护理.
- 分析与ACO参与有关的APP的工作负载分配和计费实践.
主要方法:
- 在2022年费用服务医疗保险索赔数据上利用多变量线性回归分析.
- 包括91,149个实践,其中有12,072个被确定为参与医疗保险共享储蓄计划ACO.
- 对比了门诊接触和特定服务 (健康访问,慢性护理管理等) 的比例. 由APP提供,以及间接计费率,在ACO参与和非ACO实践之间,控制实践规模和市场因素.
主要成果:
- 与非ACO实践相比,APP在ACO参与的实践中提供了较少的门诊接触.
- 在参与ACO的实践中,APP更有可能间接发票,尽管这种趋势在更大的实践中减弱了.
- 在参与ACO的实践中,APP提供的常规服务的份额通常较低,但在最大的实践四分之一中,模式更相似.
结论:
- 该研究发现,很少有证据表明,ACO利用他们的APP员工以比非ACO实践更具成本意识的方式.
- 在大多数实践类型中,APP实践模式和计费行为基于ACO参与状态并没有显著差异.
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