Clough Jeffrey D, Patel Kavita, Riley Gerald F, Rajkumar Rahul, Conway Patrick H, Bach Peter B
Jeffrey D. Clough (
Kavita Patel is managing director for clinical transformation, Engelberg Center for Health Care Reform at Brookings, in Washington, D.C.
Health Aff (Millwood). 2015 Apr;34(4):601-8. doi: 10.1377/hlthaff.2014.0964.
In recent years many policy makers have recommended alternative payment models in medical oncology in order to reduce costs and improve patient outcomes. Yet information on how oncology practices differ in their use of key service categories is limited. We measured annual payments for key service categories delivered to fee-for-service Medicare beneficiaries receiving care from 1,534 medical oncology practices in 2011-12. In 2012, differences in payments per beneficiary at the seventy-fifth-percentile practice compared to the twenty-fifth-percentile practice were $3,866 for chemotherapy (including administration and supportive care drugs), $1,872 for acute medical hospitalizations, and $439 for advanced imaging. Supportive care drugs, bevacizumab, and positron-emission tomography accounted for the greatest percentage of variation. Average practice payments for service categories were highly correlated across years but not correlated with each other, which suggests that service categories may be affected by different physician practice characteristics. These differences, even when clinical guidelines exist, demonstrate the potential for quality improvement that could be accelerated through alternative payment models.
近年来，许多政策制定者建议在肿瘤医学领域采用替代支付模式，以降低成本并改善患者治疗效果。然而，关于肿瘤医疗实践在关键服务类别使用方面的差异信息有限。我们测算2011 - 2012年期间，向1534家肿瘤医疗实践机构接受治疗的按服务收费的医疗保险受益人群提供关键服务类别的年度支付情况。2012年，处于第75百分位的医疗实践机构与第25百分位的医疗实践机构相比，每位受益人的化疗支付差异（包括给药和支持性护理药物）为3866美元，急性医疗住院支付差异为1872美元，高级影像检查支付差异为439美元。支持性护理药物、贝伐单抗和正电子发射断层扫描占变异的最大比例。各年份服务类别的平均医疗实践支付高度相关，但彼此之间不相关，这表明服务类别可能受不同医生医疗实践特征的影响。即使存在临床指南，这些差异也显示出通过替代支付模式可以加速质量改善的潜力。
