The impact of population and episode-based payment models on surgical disparities

人口和基于事件的支付模式对手术差异的影响

基本信息

批准号：
10203707
负责人：
Said A Ibrahim
金额：
$ 64.11万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-23 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10203707
关键词：
Accountability Affect Caring Coronary Artery Bypass Data Excision Face Fee-for-Service Plans Grouping Hospitalization Hospitals Incentives Individual Insurance Coverage Intestines Length of Stay Lower Extremity Medicaid Medicare Methodology Modeling Operative Surgical Procedures Outcome Patient Care Patient Selection Patient-Focused Outcomes Patients Performance Physicians Policies Population Procedures Provider Replacement Arthroplasty Research Risk Services Socioeconomic Status Spinal Fusion Surgeon Time Vulnerable Populations acute care base black patient bundled payment care costs care episode care providers cost design econometrics ethnic minority population experience experimental study hospital readmission innovation inpatient surgery insight low socioeconomic status model design mortality patient population payment peer population based racial and ethnic scale up surgical disparities

项目摘要

Project Summary As a prominent leader in the nationwide shift towards value-based payment, Medicare has implemented large fee-for-service population- and episode-based alternative payment models (APMs) that hold organizations financially accountable for the quality and costs of care. However, these APMs are not designed to protect access or outcomes for racial/ethnic minorities and individuals with low socioeconomic status. These vulnerable groups already face significant surgical disparities compared to other individuals. These disparities could worsen further under both APM types if participating providers engage in patient selection that reduces vulnerable patients’ access to surgical procedures or changes their care after participating. Because policymakers must make critical decisions about how to use different APMs to catalyze nationwide reform, insight about how population- and episode-based APMs affect surgical disparities for vulnerable patients can help policymakers determine how to best design, refine, implement policy adjustments, and scale up different models to safeguard the care of vulnerable patients. This study examines how prominent Medicare fee-for- service population- and episode-based APMs that are highly relevant to surgical care affect disparities in surgical access and outcomes for vulnerable patients, across insurance coverage type, and whether effects vary by providers’ financial attributes related to APM incentives. We hypothesize that APM participation will be associated with widened disparities in surgical access and outcomes (quality, utilization, and cost) for vulnerable vs. non-vulnerable patients after providers begin participating in APMs. We also hypothesize that the impact on surgical disparities will vary by providers’ financial attributes – experience with financial risk and payer mix – related to APM incentives.

项目摘要作为全国朝基于价值支付的著名领导者，Medicare已实施了大型持有组织的收费服务人口和基于情节的替代支付模型（APM）财务负责护理的质量和成本。但是，这些APM并非旨在保护种族/族裔少数民族和社会经济地位低下的个人的访问或结果。这些与其他人相比，脆弱的群体已经面临着重要的手术分布。这些分布如果参与的提供者参与减少的患者选择，则可能会更糟脆弱的患者参加手术程序或在参加后改变护理。因为政策制定者必须就如何使用不同的APM催化全国改革做出批判性决定，关于基于人群和情节的APM如何影响脆弱患者的手术差异的见解可以帮助决策者确定如何最好地设计，完善，实施政策调整并扩大不同维护弱势患者护理的模型。这项研究考试是如何为Medicare收费的杰出费用 - 与手术护理高度相关的基于服务人群和情节的APM会影响分布易受伤害患者的外科手术访问和结果，跨保险类型以及影响是否与APM激励措施有关的提供商的财务属性有所不同。我们假设APM参与将是与外科手术访问和结果（质量，利用和成本）中的分布扩大有关提供者开始参与APM后，脆弱的与不可杀伤的患者。我们还假设对手术差异的影响将因提供者的财务属性而有所不同 - 财务风险和付款人组合 - 与APM激励措施有关。