Heller Richard E, Coley Brian D, Simoneaux Stephen F, Podberesky Daniel J, Hernanz-Schulman Marta, Robertson Richard L, Donnelly Lane F
Radiology Partners, 2101 El Segundo Blvd., Suite 401, El Segundo, CA, 90245, USA.
Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Pediatr Radiol. 2017 Jun;47(7):776-782. doi: 10.1007/s00247-017-3857-2. Epub 2017 May 23.
Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject.
近期的政治和经济因素促使人们对医疗保健质量以及由此延伸的价值的看法发生了重大改变。虽然质量通常是根据主观标准进行评估的，但将报销与各种质量指标挂钩的按绩效付费计划需要使用客观且可量化的指标。2015年《医疗保险准入与儿童健康保险计划（CHIP）再授权法案》（MACRA）的通过加速了向基于价值的支付方式的转变。虽然这些变化的许多驱动因素都源于联邦政策和诸如医疗保险等项目，并且针对成年患者，但儿科学和儿科放射学的实践将受到越来越大的影响。本文讨论了与使用定量指标评估儿科放射科或亚专业科室所提供服务质量相关的问题，特别是从可能正在考虑将支付与绩效挂钩的支付方的角度来看。本文最后提出了一种指标分类策略，以规划该主题未来的工作。
