Pergolizzi Joseph V
Department of Medicine, Johns Hopkins, University School of Medicine, Baltimore, MD , USA.
Postgrad Med. 2015 Aug;127(6):616-22. doi: 10.1080/00325481.2015.1054616. Epub 2015 Jun 1.
Value-based purchasing (VBP) goes into effect this year and it links the quality of care to payments for care. Starting in fiscal year 2013, the Centers for Medicare and Medicaid Services reduces all inpatient prospective payment system reimbursements by 1%. This money then can be returned to hospitals in the form of a bonus through VBP. Value-based purchasing holds hospitals accountable for both cost and quality. With VBP, hospitals get a score that is based on the process of care, the outcomes, and patient-centeredness. This means that reimbursements in health care, which keep hospitals in business, are transitioning from "volume of services" to VBP. Although VBP sounds like a great idea, particularly to politicians in Washington tasked with managing out-of-control health care expenditures, there is very little high-quality evidence that VBP will actually improve care. Nevertheless, this is the way we are going to be moving forward. The perception of pain is a highly personalized phenomenon, and chronic pain affects every aspect of a patient's life. The biopsychosocial model and the concept of utilizing an interdisciplinary team approach in the management of chronic pain make sense, but there are concerns that it could result in higher overall costs and no measurable improvements in the patient's perception of care. Both results. could have a negative impact on pain specialists.
基于价值的购买（VBP）今年开始生效，它将医疗质量与医疗支付挂钩。从2013财年开始，医疗保险和医疗补助服务中心将所有住院患者前瞻性支付系统的报销额降低1%。然后这笔钱可以通过VBP以奖金的形式返还给医院。基于价值的购买要求医院对成本和质量负责。通过VBP，医院会得到一个基于医疗过程、结果和以患者为中心程度的分数。这意味着维持医院运营的医疗报销正从“服务量”向VBP转变。尽管VBP听起来是个好主意，尤其是对华盛顿那些负责管理失控的医疗支出的政客们来说，但几乎没有高质量的证据表明VBP实际上会改善医疗。然而，这就是我们要前进的方向。疼痛感知是一种高度个性化的现象，慢性疼痛会影响患者生活的方方面面。生物心理社会模型以及在慢性疼痛管理中采用跨学科团队方法的理念是有意义的，但有人担心这可能会导致总体成本上升，且患者对医疗的感知没有可衡量的改善。这两种结果都可能对疼痛专家产生负面影响。
