Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Greater Los Angeles Veteran's Affairs Health System, Los Angeles, California, USA.
J Hosp Med. 2019 Jan 8;14(1):16-21. doi: 10.12788/jhm.3084. Epub 2018 Oct 31.
Given the national emphasis on affordability, healthcare systems expect that their clinicians are motivated to provide high-value care. However, some hospitalists are reimbursed with productivity bonuses, and little is known about the effects of these reimbursements on the local culture of high-value care delivery.
To evaluate if hospitalist reimbursement models are associated with high-value culture in university, community, and safety-net hospitals.
DESIGN, SETTING, PATIENTS: Internal medicine hospitalists from 12 hospitals across California completed a cross-sectional survey assessing their perceptions of high-value care culture within their institutions. Sites represented university, community, and safety-net centers with different performances as reflected by the Centers of Medicare and Medicaid Service's Value-based Purchasing (VBP) scores.
Demographic characteristics and High-Value Care Culture Survey (HVCCSTM) scores were evaluated using descriptive statistics, and associations were assessed through multilevel linear regression.
Of the 255 hospitalists surveyed, 147 (57.6%) worked in university hospitals, 85 (33.3%) in community hospitals, and 23 (9.0%) in safety-net hospitals. Across all 12 sites, 166 (65.1%) hospitalists reported payment with salary or wages, and 77 (30.2%) with salary plus productivity adjustments. The mean HVCCS score was 50.2 (SD 13.6) on a 0-100 scale. Hospitalists reported lower mean HVCCS scores if they reported payment with salary plus productivity (β = -6.2, 95% CI -9.9 to -2.5) than if they reported payment with salary or wages.
Hospitalists paid with salary plus productivity reported lower high-value care culture scores for their institutions than those paid with salary or wages. High-value care culture and clinician reimbursement schemes are potential targets of strategies for improving quality outcomes at low cost.
鉴于国家对可负担性的重视，医疗保健系统期望其临床医生有动力提供高价值的医疗服务。然而，有些医院医生的薪酬与工作产出挂钩，对于这些薪酬与当地高价值医疗服务文化的影响知之甚少。
评估医院医生的薪酬模式是否与大学、社区和医疗保障服务网络医院的高价值文化相关。
设计、地点、患者：来自加利福尼亚州 12 家医院的内科医院医生完成了一项横断面调查，评估他们对所在机构高价值医疗服务文化的看法。这些医院分别代表大学、社区和医疗保障服务网络中心，它们在医疗保险和医疗补助服务中心的基于价值的采购（VBP）评分中表现不同。
使用描述性统计评估人口统计学特征和高价值医疗服务文化调查（HVCCSSTM）评分，通过多层次线性回归评估相关性。
在接受调查的 255 名医院医生中，147 名（57.6%）在大学医院工作，85 名（33.3%）在社区医院工作，23 名（9.0%）在医疗保障服务网络医院工作。在所有 12 个地点，166 名（65.1%）医院医生的薪酬是工资或薪水，77 名（30.2%）的薪酬是工资加生产效率调整。HVCCS 的平均得分为 50.2（SD 13.6），分值范围为 0-100。如果医院医生的薪酬是工资加生产效率调整，他们报告的 HVCCS 均值（β=-6.2，95%CI-9.9 至-2.5）比薪酬是工资或薪水的医院医生低。
与薪酬是工资或薪水的医院医生相比，薪酬是工资加生产效率调整的医院医生报告的机构高价值医疗服务文化得分更低。高价值医疗服务文化和临床医生薪酬方案是降低成本提高质量结果的潜在策略目标。
