Chen Lena M, Norton Edward C, Banerjee Mousumi, Regenbogen Scott E, Cain-Nielsen Anne H, Birkmeyer John D
Lena M. Chen (
Edward C. Norton is a professor of health management and policy in the School of Public Health, a professor of economics, a research associate at the National Bureau of Economic Research, and a professor at the Institute for Healthcare Policy and Innovation and at CHOP, University of Michigan Health System and University of Michigan.
Health Aff (Millwood). 2017 Jan 1;36(1):83-90. doi: 10.1377/hlthaff.2016.0668.
The rising popularity of episode-based payment models for surgery underscores the need to better understand the drivers of variability in spending on postacute care. Examining postacute care spending for fee-for-service Medicare beneficiaries after three common surgical procedures in the period 2009-12, we found that it varied widely between hospitals in the lowest versus highest spending quintiles for postacute care, with differences of 129 percent for total hip replacement, 103 percent for coronary artery bypass grafting (CABG), and 82 percent for colectomy. Wide variation persisted after we adjusted for the intensity of postacute care. However, the variation diminished considerably after we adjusted instead for postacute care setting (home health care, outpatient rehabilitation, skilled nursing facility, or inpatient rehabilitation facility): It decreased to 16 percent for hip replacement, 4 percent for CABG, and 21 percent for colectomy. Health systems seeking to improve surgical episode efficiency should collaborate with patients to choose the highest-value postacute care setting.
基于手术阶段付费模式的日益普及凸显了更好地了解急性后期护理支出变异性驱动因素的必要性。在研究2009年至2012年期间三种常见手术后，针对按服务收费的医疗保险受益人的急性后期护理支出，我们发现，在急性后期护理支出最低与最高的五分之一医院之间，差异很大，全髋关节置换术的差异为129%，冠状动脉搭桥术（CABG）为103%，结肠切除术为82%。在我们对急性后期护理强度进行调整后，差异仍然很大。然而，在我们改为对急性后期护理环境（家庭医疗保健、门诊康复、专业护理机构或住院康复机构）进行调整后，差异大幅减少：髋关节置换术降至16%，冠状动脉搭桥术降至4%，结肠切除术降至21%。寻求提高手术阶段效率的医疗系统应与患者合作，选择最高价值的急性后期护理环境。
