Huckfeldt Peter J, Chan Chris, Hirshman Samuel, Kofner Aaron, Liu Jodi L, Mulcahy Andrew W, Popescu Ioana, Stevens Clare, Timbie Justin W, Hussey Peter S
Rand Health Q. 2015 Jul 15;5(1):11.
This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer.
本文介绍了一项与肿瘤专科服务支付模式设计相关的研究，以供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可能的测试。癌症是一种常见且成本高昂的疾病。基于诊疗期间的支付旨在激励提供高质量、低成本的医疗服务，已被确定为肿瘤护理一种有前景的替代支付模式。基于诊疗期间的支付系统可以为医疗服务提供者提供灵活性，使其能够在最有效和高效的治疗方案中进行选择，包括目前医疗保险支付政策未涵盖的活动。然而，该模式设计还需要确保提供高质量的医疗服务，且不会不给患者提供有益的治疗。CMS要求米特里公司（MITRE）和兰德公司（RAND）进行分析，为针对接受癌症化疗治疗的医疗保险受益人的基于诊疗期间的肿瘤模型的设计决策提供依据。特别是，本研究重点分析了与化疗疗程开始定义、化疗疗程期间及前后的支出模式以及化疗疗程归因于医生执业情况相关的医疗保险理赔数据。我们发现，从初次癌症诊断到开始化疗的时间在患者之间差异很大，从一天到七年多不等，中位数为2.4个月。每月总支付的平均水平因癌症类型而异，淋巴瘤的最高支出峰值为9972美元，乳腺癌为3109美元，前列腺癌为2135美元。
