医疗保险咨询委员会(MEDPAC)对医疗服务提供系统的建议:2014 年及以后对介入性疼痛管理的影响。
Recommendations of the Medicare Payment Advisory Commission (MEDPAC) on the Health Care Delivery System: the impact on interventional pain management in 2014 and beyond.
机构信息
Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; Millennium Pain Center, Bloomington, IL; Temple University Hospital, Philadelphia, PA; and Massachusetts General Hospital and Harvard Medical School, Boston, MA.
出版信息
Pain Physician. 2013 Sep-Oct;16(5):419-40.
Continuing rise in health care costs in the United States, the Affordable Care Act (ACA), and a multitude of other regulations impact providers in 2013. Despite federal spending slowing in the past 2 years, the Board of Medicare Trustees believes that cost savings are only achievable if health care providers are able to realize productivity improvements at a quicker pace than experienced historically. Consequently, the re-engineering of U.S. health care and bridging of the divide between health and health care have been proposed beyond affordable care. Thus, the Medicare Payment Advisory Commission (MedPAC) envisions alignment of Medicare payment systems to eliminate variable rates for the same ambulatory services provided to similar patients in different settings, such as the physician's office, hospital outpatient departments (HOPDs), and ambulatory surgery centers (ASCs). MedPAC believes that if the same service can be safely provided in different settings, a prudent purchaser should not pay more for that service in one setting than in another. MedPAC is also concerned that payment variations across settings encourage arrangements among providers that result in care being provided in high paid settings. MedPAC recommends that payment rates be based on the resources needed to treat patients in the most efficient setting, adjusting for differences in patient severity, to the extent the severity differences affect costs. MedPAC has analyzed the costs of evaluation and management (E&M) services and the differences between providing them in a HOPD setting compared to a physician office setting, echocardiography services, and multiple services provided in ASCs and HOPDs. MedPAC has shown that for an established patient office visit (CPT 99213) provided in a free-standing physician's office, the program pays the physician 70% less than in HOPD setting with a payment for physician practice of $72.50 versus $123.38 for HOPD setting. Similarly, for a Level II echocardiogram, HOPD costs 141% more for the same service than a free-standing office ($188.31 versus $452.89). For interventional techniques, Medicare payments vary from physician office to HOPD setting, with $211.96 in an office setting, $407.28 in ASC setting, and $655.62 in HOPD for procedures such as epidural injections. The MedPAC proposal for changing HOPD payment rates for services would reduce program spending and result in beneficiary cost sharing by $900 million in one year. On average, hospitals' overall Medicare revenue will decline by 0.6% and HOPD revenue would fall by 2.7%. Further, MedPAC provided a specific example that aligning payment rates between HOPDs and free-standing offices only for cardiac imaging services would reduce program spending and beneficiary cost sharing by $500 million in one year. In estimating the savings that would be realized by equalizing payment rates between HOPDs and ASCs for certain ambulatory surgical procedures, MedPAC have shown potential Medicare program spending and beneficiary cost savings to be about $590 million per year. The impact of the proposed policies that are discussed in this manuscript would result in savings of approximately $1.5 billion per year for Medicare. MedPAC also has recommended a stop-loss policy that would limit the loss of Medicare revenue for those hospitals.
美国医疗保健成本持续攀升,《平价医疗法案》(ACA)和众多其他法规对 2013 年的医疗服务提供者产生了影响。尽管过去两年联邦支出有所放缓,但联邦医疗保险受托人委员会认为,只有医疗服务提供者能够以比历史上更快的速度实现生产力的提高,才能实现成本节约。因此,美国医疗保健的重新设计和弥合健康与医疗保健之间的鸿沟已经超出了可负担医疗法案的范围。因此,医疗保险支付咨询委员会(MedPAC)设想调整医疗保险支付系统,以消除为不同环境中的相似患者提供相同门诊服务的可变费率,例如医生办公室、医院门诊部门(HOPD)和门诊手术中心(ASC)。MedPAC 认为,如果相同的服务可以在不同的环境中安全地提供,那么谨慎的购买者不应该为同一服务在一个环境中支付比在另一个环境中更高的费用。MedPAC 还担心支付环境的差异会鼓励提供者之间的安排,导致服务在高付费环境中提供。MedPAC 建议根据在最有效的环境中治疗患者所需的资源来确定支付率,并根据患者严重程度进行调整,以在一定程度上影响成本。MedPAC 已经分析了评估和管理(E&M)服务的成本,以及在 HOPD 环境中与医生办公室环境相比提供这些服务的差异、超声心动图服务以及在 ASC 和 HOPD 中提供的多项服务的差异。MedPAC 表明,对于在独立医生办公室进行的已建立患者门诊就诊(CPT 99213),计划向医生支付的费用比 HOPD 环境低 70%,而 HOPD 环境的医生执业费用为 72.50 美元,而 HOPD 环境为 123.38 美元。同样,对于二级超声心动图,HOPD 为相同服务支付的费用比独立办公室高 141%($188.31 比$452.89)。对于介入技术,医疗保险的支付在医生办公室和 HOPD 环境之间有所不同,在办公室环境中为$211.96,在 ASC 环境中为$407.28,在 HOPD 环境中为$655.62,用于硬膜外注射等程序。MedPAC 改变 HOPD 服务支付率的提议将减少项目支出,并在一年内使受益人分担成本增加 9 亿美元。平均而言,医院的整体医疗保险收入将下降 0.6%,HOPD 收入将下降 2.7%。此外,MedPAC 提供了一个具体的例子,即仅对心脏成像服务在 HOPD 和独立办公室之间调整支付率,将在一年内减少项目支出和受益人分担成本 5 亿美元。在估计 HOPD 和 ASC 之间某些门诊手术程序的均等化支付率所带来的节省时,MedPAC 表明医疗保险计划支出和受益人成本节约每年约为 5.9 亿美元。本文讨论的拟议政策将使医疗保险每年节省约 15 亿美元。MedPAC 还建议实施止损政策,以限制这些医院的医疗保险收入损失。