Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York 10003, USA.
J Hosp Med. 2010 Nov-Dec;5(9):501-7. doi: 10.1002/jhm.788. Epub 2010 Aug 17.
Gainsharing is a way to provide incentives to physicians to decrease hospital costs without compromising quality.
A pay-for-performance program was instituted over a three-year period from July 2006 to June 2009. Baseline length of stay (LOS) and case costs were developed during the year prior to the inception of the program. Best practice norms (BPNs) were established at the top 25th percentile of physicians for each all patient refined (APR)-diagnosis related group (DRG). Hospital costs were analyzed in several areas, including operating room charge (OR), supplies and implants, nursing and per-diem room costs. Payments were based upon case level performance compared to BPN's and the physician's historic performance. Eligible cases included commercial insurance only for the first 2 years but Medicare cases were included after October 2008 resulting from a Centers for Medicare and Medicaid Services (CMS)-approved demonstration project. Payments to physicians required meeting quality thresholds, including chart completion, and compliance with core measures.
A total of 184 (54%) physicians enrolled into the program. There was a $25.1 million reduction in hospital costs during the 3 years ($16 million from participating and $9.1 million from non-participating physicians, P < 0.01). Most cost reductions were attributed to reduced LOS and reductions in medical supply costs. Total physician payouts were over $2 million (average $1,866 per quarter). Delinquent medical records decreased from an average of 43% in the second quarter 2006 to 30% (P < 0.0001) in the second quarter 2009. Quality measures improved during the study period but not by a statistical significance.
Gainsharing provided an incentive for physicians to reduce hospital costs while maintaining hospital quality.
收益分享是一种激励医生降低医院成本而不影响质量的方法。
从 2006 年 7 月至 2009 年 6 月，实施了为期三年的按效付费计划。在该计划实施前的一年，制定了基线住院时间（LOS）和病例成本。最佳实践规范（BPN）是为每个全患者精细化（APR）-诊断相关组（DRG）的前 25%的医生设立的。医院成本在多个领域进行了分析，包括手术室收费（OR）、供应品和植入物、护理和按日计费房费。根据病例水平的表现与 BPN 和医生的历史表现进行比较，对医生进行支付。符合条件的病例仅包括前两年的商业保险，但由于医疗保险和医疗补助服务中心（CMS）批准的示范项目，从 2008 年 10 月开始，包括医疗保险病例。向医生支付款项需要满足质量阈值，包括图表完成和遵守核心措施。
共有 184 名（54%）医生参加了该计划。在 3 年期间，医院成本减少了 2510 万美元（参与的医生减少了 1600 万美元，非参与的医生减少了 910 万美元，P < 0.01）。大部分成本降低归因于 LOS 缩短和医疗供应成本降低。医生总支出超过 200 万美元（平均每季度 1866 美元）。逾期病历从 2006 年第二季度的平均 43%下降到 2009 年第二季度的 30%（P < 0.0001）。在研究期间，质量措施有所改善，但没有统计学意义。
收益分享为医生提供了降低医院成本的激励，同时保持了医院的质量。
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