Lin Eugene, MaCurdy Thomas, Bhattacharya Jay
Division of Nephrology, Department of Medicine and
Center for Health Policy, Stanford University School of Medicine, Stanford, California; and.
J Am Soc Nephrol. 2017 Sep;28(9):2590-2596. doi: 10.1681/ASN.2017040407. Epub 2017 Jul 28.
In response to rising Medicare costs, Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act in 2015. The law fundamentally changes the way that health care providers are reimbursed by implementing a pay for performance system that rewards providers for high-value health care. As of the beginning of 2017, providers will be evaluated on quality and in later years, cost as well. High-quality, cost-efficient providers will receive bonuses in reimbursement, and low-quality, expensive providers will be penalized financially. The Centers for Medicare and Medicaid Services will evaluate provider costs through episodes of care, which are currently in development, and alternative payment models. Although dialysis-specific alternative payment models have already been implemented, current models do not address the transition of patients from CKD to ESRD, a particularly vulnerable time for patients. Nephrology providers have an opportunity to develop cost-efficient ways to care for patients during these transitions. Efforts like these, if successful, will help ensure that Medicare remains solvent in coming years.
为应对医疗保险成本的不断上升，国会于2015年通过了《医疗保险准入与儿童健康保险计划再授权法案》。该法律通过实施按绩效付费系统从根本上改变了医疗服务提供者的报销方式，该系统对提供高价值医疗服务的提供者给予奖励。截至2017年初，将对医疗服务提供者进行质量评估，在随后几年还将评估成本。高质量、成本效益高的医疗服务提供者将获得报销奖金，而质量低、成本高的医疗服务提供者将受到经济处罚。医疗保险和医疗补助服务中心将通过目前正在制定的护理事件和替代支付模式来评估医疗服务提供者的成本。虽然已经实施了针对透析的替代支付模式，但目前的模式并未涉及患者从慢性肾脏病到终末期肾病的过渡阶段，而这对患者来说是一个特别脆弱的时期。肾脏病医疗服务提供者有机会在这些过渡阶段开发出具有成本效益的患者护理方式。如果这些努力取得成功，将有助于确保医疗保险在未来几年仍具偿付能力。
