Das Anup, Norton Edward C, Miller David C, Ryan Andrew M, Birkmeyer John D, Chen Lena M
Anup Das (
Edward C. Norton is a professor in the Department of Health Management and Policy, the Department of Economics, and the Institute for Healthcare Policy and Innovation, all at the University of Michigan, and a research associate of the National Bureau of Economic Research, in Cambridge, Massachusetts.
Health Aff (Millwood). 2016 May 1;35(5):898-906. doi: 10.1377/hlthaff.2015.1190.
In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. This represented a sharp departure from the program's original efforts to incentivize hospitals for quality alone. How this change redistributed hospital bonuses and penalties was unknown. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, we found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well. Thirty-eight percent of low-spending hospitals received bonuses in fiscal year 2014, compared to 100 percent in fiscal year 2015. However, low-quality hospitals also began to receive bonuses (0 percent in fiscal year 2014 compared to 17 percent in 2015). All high-quality hospitals received bonuses in both years. The Centers for Medicare and Medicaid Services should consider incorporating a minimum quality threshold into the Hospital Value-Based Purchasing program to avoid rewarding low-quality, low-spending hospitals.
2015财年，医疗保险和医疗补助服务中心扩大了其基于医院价值的采购计划，根据医院在支出和质量方面的表现对其进行奖励或惩罚。这与该计划最初仅激励医院提高质量的努力有很大不同。尚不清楚这种变化是如何重新分配医院的奖金和惩罚的。利用2014年和2015财年参与该计划的2679家美国医院的数据，我们发现，对支出的新重视不仅奖励了低支出医院，也奖励了一些低质量医院。2014财年，38%的低支出医院获得了奖金，而2015财年这一比例为100%。然而，低质量医院也开始获得奖金（2014财年为0%，2015年为17%）。所有高质量医院在这两年都获得了奖金。医疗保险和医疗补助服务中心应考虑在基于医院价值的采购计划中纳入最低质量门槛，以避免奖励低质量、低支出的医院。
