Lehigh University, Bethlehem, PA 18015-3117, USA.
Med Care Res Rev. 2012 Feb;69(1):62-82. doi: 10.1177/1077558711409946. Epub 2011 Oct 4.
In 2008, Medicare implemented a new payment policy for ambulatory surgical centers (ASCs), which aligns the ASC payment system with that used for hospital outpatient departments and reimburses ASCs approximately 65% of what hospitals receive for the same outpatient surgery. The authors assess patient selection across ASCs and hospital outpatient departments for four common surgeries (colonoscopy, hernia repair, knee arthroscopy, cataract repair), using data on procedures performed in Florida from 2004 to 2008. The authors construct measures of patient illness severity and cost risk and find that ASCs benefit from positive selection. Nonetheless, the degree of selection varies by surgery type and patient population. While similar studies in other states are needed, the findings suggest that modifications to the Medicare outpatient payment system may be appropriate to account for the different populations that each setting attracts.
2008 年，医疗保险为流动外科中心（ASCs）实施了新的支付政策，该政策使 ASC 的支付系统与医院门诊部门的支付系统保持一致，并向 ASC 支付与医院为相同门诊手术收取的费用大致 65%的费用。作者使用佛罗里达州 2004 年至 2008 年的手术数据，评估了四种常见手术（结肠镜检查、疝修补术、膝关节镜检查、白内障手术）在 ASC 和医院门诊部门的患者选择情况。作者构建了衡量患者疾病严重程度和成本风险的指标，发现 ASC 受益于积极的选择。尽管如此，选择的程度因手术类型和患者人群而异。虽然需要在其他州进行类似的研究，但这些发现表明，可能需要对医疗保险门诊支付系统进行修改，以考虑到每个设置所吸引的不同人群。
