Hirth Richard A, Turenne Marc N, Wheeler John R C, Pozniak Alyssa S, Tedeschi Philip, Chuang Chien-Chia, Pan Qing, Slish Kathryn, Messana Joseph M
University of Michigan School of Public Health, Department of Health Management and Policy, 109 South Observatory, Ann Arbor, MI 48109-2029, USA.
J Am Soc Nephrol. 2007 Sep;18(9):2565-74. doi: 10.1681/ASN.2006090949. Epub 2007 Aug 5.
Medicare is considering an expansion of the bundle of dialysis-related services to be paid on a prospective basis. Exploratory models were developed to assess the potential limitations of case-mix adjustment for such an expansion. A broad set of patient characteristics explained 11.8% of the variation in Medicare allowable charges per dialysis session. Although adding recent hematocrit values or prior health care utilization to the model did increase explanatory power, it could also create adverse incentives. Projected gains or losses relative to prevailing fee-for-service payments, assuming no change in practice patterns, were significant for some individual providers. However, systematic gains or losses for different classes of providers were modest.
医疗保险正在考虑扩大按预期支付的透析相关服务包。已开发探索性模型来评估这种扩大情况下病例组合调整的潜在局限性。一系列广泛的患者特征解释了每次透析疗程医疗保险允许收费变化的11.8%。虽然将近期血细胞比容值或先前的医疗保健利用率添加到模型中确实增加了解释力，但也可能产生不良激励。假设实践模式不变，相对于现行的按服务收费支付方式，预计一些个体提供者会有显著的收益或损失。然而，不同类别提供者的系统性收益或损失并不显著。
