医疗保险医院再入院减少计划下教学和保障网医院避免再入院的财务影响。
The Financial Impact of an Avoided Readmission for Teaching and Safety-Net Hospitals Under Medicare's Hospital Readmission Reduction Program.
机构信息
University of Michigan School of Nursing, Ann Arbor, USA.
Alexandria, VA, USA.
出版信息
Med Care Res Rev. 2020 Aug;77(4):324-333. doi: 10.1177/1077558718795733. Epub 2018 Aug 24.
We examined the financial incentives to avoid readmissions under Medicare's Hospital Readmission Reduction Program for safety-net hospitals (SNHs) and teaching hospitals (THs) compared with other hospitals. Using Medicare's FY2016 Hospital Compare and readmissions data for 2,465 hospitals, we tested for differential revenue gains for SNHs ( = 658) relative to non-SNHs ( = 1,807), and for major ( = 231) and minor ( = 591) THs relative to non-THs ( = 1,643). We examined hospital-level factors predicting differences in revenue gains by hospital type. The revenue gains of an avoided readmission were 10% to 15% greater for major THs compared with non-THs ($18,047 vs. $15,478 for acute myocardial infarction) but no different for SNHs compared with non-SNHs. The greater revenue gains for THs were strongly positively predicted by hospitals' poor initial readmission performance. We found little evidence that the Hospital Readmission Reduction Program creates disincentives for SNHs and THs to invest in readmission reduction efforts, and THs have greater returns from readmissions avoidance than non-THs.
我们考察了医疗保险安全网医院（SNH）和教学医院（TH）与其他医院相比，在避免再入院方面的财务激励措施，以评估 Medicare 的 Hospital Readmission Reduction Program 的效果。我们使用 Medicare 的 FY2016 Hospital Compare 和再入院数据，对 2465 家医院进行了测试，考察了 SNH（=658）与非 SNH（=1807）之间、主要 TH（=231）和次要 TH（=591）与非 TH（=1643）之间的收入差异。我们考察了医院层面的因素，这些因素可以预测医院类型的收入差异。与非 TH 相比，主要 TH 避免一次再入院可获得的收入增益高出 10%至 15%（急性心肌梗死为 18047 美元，而非 TH 为 15478 美元），但 SNH 与非 SNH 之间没有差异。TH 的更高收入增益与医院较差的初始再入院表现呈正相关。我们发现，几乎没有证据表明 Hospital Readmission Reduction Program 会对 SNH 和 TH 产生避免投入再入院的激励，而 TH 从避免再入院中获得的回报要高于非 TH。
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