Dowd Bryan E, Swenson Tami, Parashuram Shriram, Coulam Robert, Kane Robert
University of Minnesota, Minneapolis, MN, USA
University of Minnesota, Minneapolis, MN, USA.
Med Care Res Rev. 2016 Feb;73(1):106-23. doi: 10.1177/1077558715597846. Epub 2015 Aug 30.
Medicare's Physician Quality Reporting System (PQRS) is the largest quality-reporting system in the U.S. health care system and a basis for the new value-based modifier system for physician payment. The PQRS allows health care providers to report measures of quality of care that include both the process of care and physiological outcomes. Using a multivariate difference-in-differences model, we examine the relationship of PQRS participation to three claims-computable measures of inappropriate utilization of health care services and risk-adjusted per capita Medicare expenditures. The data are a national random sample of PQRS-participating providers matched to nonparticipating providers by zip code and caseload. We found few significant relationships in the overall analysis. However, the magnitude and statistical significance of the desirable associations increased in subgroups of providers and beneficiaries more prone to overutilization (e.g., males, older beneficiaries, beneficiaries treated in larger medical practices or by nonphysicians, and practices in rural areas), and among beneficiaries with heart conditions, diabetes, and eye problems.
医疗保险的医师质量报告系统（PQRS）是美国医疗保健系统中最大的质量报告系统，也是新的基于价值的医师薪酬调整系统的基础。PQRS允许医疗保健提供者报告护理质量指标，这些指标既包括护理过程，也包括生理结果。我们使用多变量差分模型，研究参与PQRS与医疗保健服务不当使用的三项可通过索赔计算的指标以及风险调整后的人均医疗保险支出之间的关系。数据是按邮政编码和病例数量与未参与的提供者匹配的参与PQRS的提供者的全国随机样本。在总体分析中，我们发现几乎没有显著关系。然而，在更容易过度使用医疗服务的提供者和受益人群体（如男性、老年受益人、在大型医疗实践中接受治疗或由非医师治疗的受益人以及农村地区的医疗实践）中，以及在患有心脏病、糖尿病和眼部问题的受益人中，理想关联的幅度和统计显著性有所增加。
