Mulcahy Andrew W, Chan Chris, Hirshman Samuel, Huckfeldt Peter J, Kofner Aaron, Liu Jodi L, Lovejoy Susan L, Popescu Ioana, Timbie Justin W, Hussey Peter S
Rand Health Q. 2015 Jul 15;5(1):10.
Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model.
胃肠病学和心脏病学服务在医疗保险受益人中很常见且成本高昂。基于诊疗 episode 的支付方式旨在激励提供高质量、低成本的医疗服务，已被视为一种有前景的替代支付模式。本文介绍了与基于诊疗 episode 的支付模式设计相关的研究，该模式用于门诊胃肠病学和心脏病学服务，可能会由医疗保险和医疗补助服务中心（CMS）的医疗保险和医疗补助创新中心进行测试。作者分析了医疗保险理赔数据，以描述胃肠病学和心脏病学索引程序的频率和特征、实施索引程序的医疗机构以及接受索引程序的患者。这些分析结果有助于为 CMS 在基于诊疗 episode 的支付模式中关于诊疗 episode 的定义、服务环境、多项程序或其他因素的支付调整以及支付模式资格等方面的决策提供参考。
