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护理改善的捆绑支付先进:对医院和CMS支出的影响,2018-21年
Andrew M Ryan1, Yan Lin2, Jason D Buxbaum3
1Andrew M. Ryan (andrew_m_ryan@brown.edu), Brown University, Providence, Rhode Island.
Health affairs (Project Hope)
|February 2, 2026
概括
综合支付护理改进先进模型 (BPCI-A) 减少了医院支出,但由于巨额激励支付,导致医疗保险和医疗补助服务中心 (CMS) 净亏损. 这种自愿捆绑支付模式对CMS的预算影响最小.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 支付改革是为了改革支付方式.
背景情况:
- 护理改进先进模式 (BPCI-A) 的捆绑支付旨在降低医疗保健支出,并为医疗保险和医疗补助服务中心 (CMS) 创造节省.
- 该模型的设计在四年内发展,但其对医院和CMS支出的综合影响在此期间仍然未经检查.
研究的目的:
- 评估"护理改进捆绑支付先进模型" (BPCI-A) 对医院和医疗保险支出的影响.
- 分析不同模型年和参与和非参与医院的护理情节的支出变化.
主要方法:
- 使用了合成差异差异分析.
- 使用了2014年4月至2021年12月期间100%的医疗保险收费服务受益者数据样本.
- 对比了883所参与医院与1772所非参与医院的支出变化.
主要成果:
- BPCI-A实现了每家医院90天病期支出平均减少324美元,在模型年3和4中观察到更大的减少.
- 在骨科和神经保健病例中,有显著的支出减少.
- 尽管医院节省了资金,但大量的激励支付导致CMS在研究期间的净损失为1.71亿美元,尽管模型年4显示了净储蓄.
结论:
- BPCI-A导致支付从熟练护理机构转移到医院,对CMS预算的整体影响最小.
- 该研究表明,自愿的捆绑支付模式可能无法有效地为CMS带来实质性节约.
- 对替代支付模式的进一步研究是有必要的,以实现医疗保险的有意义的成本降低.
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