Quinn Kevin
ACS Government Healthcare Solutions, Helena, Montana 59601, USA.
J Ambul Care Manage. 2010 Jan-Mar;33(1):38-49; discussion 69-70. doi: 10.1097/JAC.0b013e3181cfc12a.
As Medicaid spending rises quickly, controlling cost while coordinating care and improving quality is paramount. Payment method reforms should reward providers that deliver beneficial care but not care of marginal value. This article draws lessons from previous payment reforms and analyzes the potential benefits for Medicaid of 7 specific proposals. The most promising are paying for quality (especially rewarding hospitals that reduce rates of potentially preventable complications and readmissions) and moving away from fee-for-service payment for "medical home" providers. To achieve reform, the article recommends a process characterized by persistence, attention to outliers, consultation, and timing.
随着医疗补助支出迅速增加,在协调医疗服务的同时控制成本并提高质量至关重要。支付方式改革应奖励提供有益医疗服务的供应商,而非提供边际价值医疗服务的供应商。本文借鉴了以往支付改革的经验教训,并分析了7项具体提议对医疗补助的潜在益处。最具前景的提议是按质量付费(尤其奖励那些降低潜在可预防并发症和再入院率的医院),以及不再对“医疗之家”供应商采用按服务收费的支付方式。为实现改革,本文建议采用一个具有持久性、关注异常值、进行磋商和把握时机等特点的流程。