College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
BMC Health Serv Res. 2012 Dec 17;12:464. doi: 10.1186/1472-6963-12-464.
Medicare hospital Value-based purchasing (VBP) program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are associated with a hospital's VBP score, and consequently incentive payments.The objective of the study was to assess the association of hospital characteristics with (i) the mean VBP score, and (ii) specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC) score and patient satisfaction score.
Observational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS) regression and quantile regression (QR), respectively.
VBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit), smaller bed size (vs. 100-199 beds), East South Central region (vs. New England region) and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients) were positively associated with mean VBP scores (p<0.01 in all). Total number of CPC measures reported, bed size of 400-499 (vs. 100-199 beds), a few geographic regions (Mid-Atlantic, West North Central, Mountain and Pacific) compared to the New England region were negatively associated with mean VBP score (p<0.01 in all). Disproportionate share index, proportion of Medicare and Medicaid days to total inpatient days had significant (p<0.01) but small effects. QR results indicate evidence of differential effects of some of the hospital characteristics across low-, medium- and high-quality providers.
Although hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.
医疗保险医院基于价值的购买（VBP）计划将医疗保险支付与医疗质量联系起来，该计划将于 2013 年生效。目前尚不清楚特定的医院特征是否与医院的 VBP 评分相关，以及与激励性支付相关。本研究的目的是评估医院特征与（i）平均 VBP 评分，以及（ii）VBP 评分分布的特定百分位数的关联。次要目标是量化医院特征与 VBP 评分组成部分的关联：临床护理过程（CPC）评分和患者满意度评分。
使用来自三个来源的数据进行观察性分析：医疗保险医院比较数据库、美国医院协会 2010 年年度调查和医疗保险影响文件。最终的研究样本包括 2491 家有资格参加 VBP 计划的美国急性护理医院。使用普通最小二乘法（OLS）回归和分位数回归（QR）分别评估医院特征与平均 VBP 评分和特定 VBP 评分百分位数的关联。
VBP 评分存在很大差异，在 VBP 评分分布的第一和第四四分位数中，平均评分为 30 和 60。营利性（vs. 非营利性）、较小的床位数（vs. 100-199 张床）、东南中部地区（vs. 新英格兰地区）和特定 CPC 措施报告（出院指导、及时提供抗生素和β受体阻滞剂、以及心脏手术患者的血清葡萄糖控制）与平均 VBP 评分呈正相关（所有 p<0.01）。报告的 CPC 措施总数、400-499 张床的床位数（vs. 100-199 张床）、与新英格兰地区相比，少数几个地理区域（大西洋中部、中西部、山区和太平洋地区）与平均 VBP 评分呈负相关（所有 p<0.01）。不成比例的份额指数、医疗保险和医疗补助天数占总住院天数的比例有显著影响（p<0.01），但影响较小。QR 结果表明，一些医院特征对低、中、高质量提供者的影响存在差异。
尽管为贫困人口和老年人服务的医院在 VBP 计划下得分较低的可能性更大，但这种相关性似乎很小。盈利状况、地理位置、报告的 CPC 措施数量和类型解释了评分中最大的差异。
