Fuller Richard L, McCullough Elizabeth C, Averill Richard F
3M Health Information Systems, Silver Spring, MD 20904, USA.
Inquiry. 2011 Spring;48(1):68-83. doi: 10.5034/inquiryjrnl_48.01.07.
This article proposes a redesign of the Medicare inpatient prospective payment system to reduce payments made to hospitals with high complication rates. We compute risk-adjusted, expected complication rates for hospitals and compare them to actual complication rates in order to determine the number of excess complications. Hospital payment reductions then are computed based on the number of excess complications in a hospital. Medicare hospital payment could be reduced by approximately 8% (8.5 billion dollars) if hospitals were held to a "best practice" standard and if payments made for excess complications were eliminated.
本文提出了对医疗保险住院患者前瞻性支付系统的重新设计，以减少向并发症发生率高的医院支付的费用。我们计算医院的风险调整后预期并发症发生率，并将其与实际并发症发生率进行比较，以确定额外并发症的数量。然后根据医院额外并发症的数量来计算医院支付的减少额。如果要求医院达到“最佳实践”标准并消除对额外并发症的支付，医疗保险医院支付可能会减少约8%（85亿美元）。
