Kim Dong H, Dagi T Forcht, Bean James R
Department of Neurosurgery, The University of Texas Medical School at Houston, Houston, Texas.
‡The Center for Medical Ethics, Harvard University, Cambridge, Massachusetts.
Neurosurgery. 2017 Apr 1;80(4S):S4-S9. doi: 10.1093/neuros/nyx008.
Neurosurgery is experiencing a period of acute change driven by 2 forces: (1) the perception that the healthcare system in the United States is wasteful and that patients are receiving low "value" care, (2) the belief that quality and long-term outcomes can be measured accurately. We believe 3 important shifts will emerge as a result of these forces. First, payment models will change. They will become anchored to a concept of population health, with capitation payments on a per-patient basis going to provider entities that undertake financial risk. Second, fee-for-service payments will be tied increasingly to administrative and clinical quality measures. Finally, out-of-pocket costs for patients will increase and affect both treatment decisions and willingness to participate in restrictive health care networks. In this review, we describe these changes and discuss possible consequences. We note the changing demographics of neurosurgical practices. Overall, independent private practices, managed by the neurosurgeons, will decline. The proportion of fee-for-service cases will decrease while cases reimbursed through capitation will increase. Physician integration with provider organizations, whether via full employment, a "lease," or some other arrangement, will also increase. We note the increasing importance of quality measures, and how they are likely to affect neurosurgical practices and reimbursement. We describe the advantages and disadvantages of fee-for-service and population health; describe opportunities and risks arising from these transitions; and outline strategies to thrive in a changing environment.
（1）认为美国的医疗体系存在浪费现象，患者接受的是低“价值”护理；（2）相信质量和长期结果能够得到准确衡量。我们认为，这些力量将导致三个重要转变。首先，支付模式将会改变。它们将以人群健康的概念为基础，按人头向承担财务风险的医疗服务提供实体支付费用。其次，按服务收费将越来越多地与行政和临床质量指标挂钩。最后，患者的自付费用将会增加，并影响治疗决策以及参与限制性医疗网络的意愿。在这篇综述中，我们描述了这些变化并讨论了可能产生的后果。我们注意到神经外科医疗业务中不断变化的人口统计学特征。总体而言，由神经外科医生管理的独立私人诊所将会减少。按服务收费的病例比例将会下降，而通过人头付费报销的病例将会增加。医生与医疗服务提供组织的整合，无论是通过全职雇佣、“租赁”还是其他某种安排，也将会增加。我们注意到质量指标的重要性日益增加，以及它们可能如何影响神经外科医疗业务和报销。我们描述了按服务收费和人群健康的优缺点；描述了这些转变带来的机遇和风险；并概述了在不断变化的环境中蓬勃发展的策略。
