医疗保险的转型事件问责模型 (TEAM) 医疗保险的转型事件问责模型 (TEAM) 参与者和非参与者医院之间的医院特点和事件成本差异捆绑付款计划
Brook I Martin1, Sohail K Mirza2, Hyunkyu Ko3
1Associate Professor, Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108.
概括
医疗保险的脊髓融合手术 (TEAM) 捆绑支付模式包括成本较高的医院,导致参与者与非参与者相比支付更高的病例成本. 这些发现表明,医院在满足TEAM倡议下的区域目标价格方面面临着挑战.
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
- 外科手术的结果
背景情况:
- 医疗保险的转型事件问责模式 (TEAM) 是针对特定手术事件的强制性捆绑支付计划.
- 该模型针对18种类型的脊髓融合手术,以加强护理协调和降低成本.
研究的目的:
- 为了比较TEAM参与者与非参与者之间的医院特征和事件成本.
- 分析与区域目标价格相比,用于融合手术的医院特定事件成本的变化.
主要方法:
- 对医院特征的横截面分析和对30天病例成本的回顾性队列分析.
- 医疗保险服务费索赔数据 (2016-2021) 脊柱融合手术,不包括某些患者群体和复杂的融合.
- 调整了患者和医院因素的通用线性回归模型,以比较事件成本.
主要成果:
- 团队医院更大,费用更高,更可能是学术或创伤中心.
- 调整后的30天的节目成本为TEAM参与者 (42,880美元) 和非参与者 (41,289美元) 的1590美元.
- 参与和非参与医院之间的门诊融合成本没有显著差异.
结论:
- 融合程序的插件成本存在显著差异,这给实现区域目标价格带来了挑战.
- 团队参与集中在成本较高的医院中,可能是由于未调整的患者严重程度或资源利用.
- 强制性TEAM参与可能需要成本较高的医院实施成本降低策略,以实现财务目标.
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