Accountable care organizations and the diffusion of new surgical procedures

负责任的护理组织和新外科手术的传播

• 批准号: 9522804
• 负责人: BRENT K. HOLLENBECK
• 金额: $ 52.2万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-15 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9522804
• 关键词: Adopted; Biological Products; Caregivers; Caring; Clinical; Communication; Cost Control; Costs and Benefits; Data; Development; Devices; Diffusion; Evidence Based Medicine; Fostering; Future; Growth; Health Care Reform; Health Expenditures; Health system; Healthcare; Heterogeneity; Hospitals; Image; Incentives; Information Technology; Intervention; Measures; Medical; Medicare; Methods; Operative Surgical Procedures; Organizational Policy; Patient Care; Patients; Physicians; Play; Policies; Population; Procedures; Risk; Role; Savings; System; Technology; Testing; base; cost; design; financial incentive; improved; new technology; payment; programs; public health relevance; shared decision making; technology diffusion

 DESCRIPTION (provided by applicant): The development and dissemination of new technology is a major determinant of growth in Medicare spending. New biological agents, imaging tests, and devices are among the many sectors of new technology that play a disproportionate role in health expenditures. However, an important contributor to growth in technology spending, and oft underappreciated, is the dissemination of new surgical procedures. Discouraging the dissemination of low value technologies has long been a priority for payers and policymakers. Many hope that accountable care organizations (ACOs) will do just that. A fundamental reform of both Pioneer and Medicare Shared Savings Program ACOs is to unite physicians, hospitals and other caregivers under a single entity to provide more integrated care. Additionally, ACOs imply a considerable change from traditional reimbursement, involving modest financial risk initially, but ultimately resulting in partially capitated payments in some cases. A better understanding of the effects of ACOs on the use of new surgical procedures would be important for anticipating the broader implications of health reform for technology diffusion and cost containment. To examine this issue more carefully, this proposal has three aims. Aim 1: To assess the impact of ACOs on the substitution of surgical technologies for existing therapies. Using national Medicare data, we will determine how health systems substitute new procedures for old ones, focusing in particular on the heterogeneity in effects across technologies according to their value. Aim 2: To measure the impact of ACOs on treatment expansion associated with surgical technologies. Using similar methods, we will assess the extent to which health systems expand the population treated, focusing on the heterogeneity in effects across patients within a procedure. Aim 3: To determine the effect of escalating financial incentives to select ACOs on the use of surgical technologies. We will assess the use of procedures before and after the commencement of partially capitated payments to select ACOs. An improved understanding of the potential impact of ACOs on surgical technology diffusion is central to anticipating future Medicare spending growth. This proposal has real world implications for payers and policymakers as they struggle with designing effective policies to improve the efficiency of the delivery system.

 描述（由申请人提供）：新技术的开发和传播是医疗保险支出增长的主要决定因素，新的生物制剂、成像测试和设备是在卫生支出中发挥不成比例作用的众多新技术领域之一。然而，技术支出增长的一个重要贡献者却常常被低估，那就是新外科手术的传播，长期以来，阻止低价值技术的传播一直是支付者和政策制定者的首要任务。 Pioneer 和 Medicare 共享储蓄计划 ACO 的根本性改革是将医生、医院和其他护理人员联合到一个实体下，以提供更综合的护理。此外，ACO 意味着与传统的巨大变化。报销，最初涉及适度的财务风险，但最终在某些情况下导致部分按人头支付。更好地了解 ACO 对使用新外科手术的影响对于预测医疗改革对技术传播和发展的更广泛影响非常重要。为了更仔细地研究这个问题，该提案有三个目标：利用国家医疗保险数据评估 ACO 对手术技术替代的影响，我们将确定卫生系统如何替代新手术。目标 2：为了衡量 ACO 对与外科技术相关的治疗扩展的影响，我们将评估卫生系统扩大治疗范围的程度。人口，治疗重点是目标 3：确定对选定的 ACO 不断升级的经济激励对手术技术使用的影响。我们将在开始对选定的 ACO 进行部分按人头付费之前和之后评估手术的使用情况。更好地了解 ACO 对外科技术扩散的潜在影响对于预测未来医疗保险支出增长至关重要。该提案对支付者和政策制定者具有现实意义，因为他们正在努力设计有效的政策来提高交付系统的效率。