Sarwar Ammar, Boland Giles, Monks Annamarie, Kruskal Jonathan B
From the Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA 02215 (A.S., A.M., J.B.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.B.); and Harvard Medical School, Boston, Mass (A.S., G.B., J.B.K.).
Radiographics. 2015 May-Jun;35(3):866-76. doi: 10.1148/rg.2015140221. Epub 2015 Apr 3.
Accelerated by the Patient Protection and Affordable Care Act of 2010, health care delivery in the United States is poised to move from a model that rewards the volume of services provided to one that rewards the value provided by such services. Radiology department operations are currently managed by an array of metrics that assess various departmental missions, but many of these metrics do not measure value. Regulators and other stakeholders also influence what metrics are used to assess medical imaging. Metrics such as the Physician Quality Reporting System are increasingly being linked to financial penalties. In addition, metrics assessing radiology's contribution to cost or outcomes are currently lacking. In fact, radiology is widely viewed as a contributor to health care costs without an adequate understanding of its contribution to downstream cost savings or improvement in patient outcomes. The new value-based system of health care delivery and reimbursement will measure a provider's contribution to reducing costs and improving patient outcomes with the intention of making reimbursement commensurate with adherence to these metrics. The authors describe existing metrics and their application to the practice of radiology, discuss the so-called value equation, and suggest possible metrics that will be useful for demonstrating the value of radiologists' services to their patients.
在2010年《患者保护与平价医疗法案》的推动下,美国的医疗服务提供模式正准备从奖励所提供服务数量的模式转向奖励此类服务所提供价值的模式。放射科的运营目前由一系列评估不同部门任务的指标管理,但其中许多指标并未衡量价值。监管机构和其他利益相关者也会影响用于评估医学成像的指标。诸如医师质量报告系统等指标越来越多地与经济处罚挂钩。此外,目前缺乏评估放射科对成本或结果贡献的指标。事实上,在没有充分了解其对下游成本节约或患者结果改善的贡献的情况下,放射科被广泛视为医疗成本的一个因素。新的基于价值的医疗服务提供和报销系统将衡量提供者对降低成本和改善患者结果的贡献,目的是使报销与遵守这些指标相称。作者描述了现有指标及其在放射科实践中的应用,讨论了所谓的价值等式,并提出了可能有助于向患者证明放射科医生服务价值的指标。