医院直接向麻醉科支付费用的趋势：加利福尼亚非学术型医院的回顾性队列研究。

Trends in Direct Hospital Payments to Anesthesia Groups: A Retrospective Cohort Study of Nonacademic Hospitals in California.

机构信息

From the Department of Anesthesiology, Pain, and Perioperative Medicine and Department of Health Research and Policy (E.C.S.) Stanford University School of Medicine (C.O'C.), Stanford, California the Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa (F.D.) the Mayo Clinic School of Medicine, Rochester, Minnesota (D.J.M.).

出版信息

Anesthesiology. 2019 Sep;131(3):534-542. doi: 10.1097/ALN.0000000000002819.

DOI:10.1097/ALN.0000000000002819

PMID:31283739

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7583316/

Abstract

BACKGROUND

In addition to payments for services, anesthesia groups in the United States often receive revenue from direct hospital payments. Understanding the magnitude of these payments and their association with the hospitals' payer mixes has important policy implications.

METHODS

Using a dataset of financial reports from 240 nonacademic California hospitals between 2002 and 2014, the authors characterized the prevalence and magnitude of direct hospital payments to anesthesia groups, and analyzed the association between these payments and the fraction of anesthesia revenue derived from public payers (e.g., Medicaid).

RESULTS

Of hospitals analyzed, 69% (124 of 180) made direct payments to an anesthesia group in 2014, compared to 52% (76 of 147) in 2002; the median payment increased from $242,351 (mean, $578,322; interquartile range, $72,753 to $523,861; all dollar values in 2018 U.S. dollars) to $765,128 (mean, $1,295,369; interquartile range, $267,006 to $1,503,163) during this time period. After adjusting for relevant covariates, hospitals where public insurers accounted for a larger fraction of anesthesia revenues were more likely to make direct payments to anesthesia groups (β = 0.45; 95% CI, 0.10 to 0.81; P = 0.013), so that a 10-percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 4.5-percentage point increase in the probability of receiving any payment. Among hospitals making payments, our results (β = 2.10; 95% CI, 0.74 to 3.45; P = 0.003) suggest that a 1-percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 2% relative increase in the amount paid.

CONCLUSIONS

Direct payments from hospitals are becoming a larger financial consideration for anesthesia groups in California serving nonacademic hospitals, and are larger for groups working at hospitals serving publicly insured patients.

摘要

背景

除了服务报酬外，美国的麻醉科团体通常还会从医院的直接付款中获得收入。了解这些付款的规模及其与医院付款方组合的关系具有重要的政策意义。

方法

本研究使用了 2002 年至 2014 年加利福尼亚州 240 家非学术性医院的财务报告数据集，作者对向麻醉科团体支付的直接医院款项的流行程度和规模进行了描述，并分析了这些款项与麻醉收入中来自公共支付者（例如医疗补助）的部分之间的关联。

结果

在所分析的医院中，2014 年有 69%（180 家中有 124 家）向麻醉科团体支付了直接款项，而 2002 年这一比例为 52%（147 家中有 76 家）；中位支付额从 2018 年的 242351 美元（均值为 578322 美元，四分位距为 72753 美元至 523861 美元）增加到 765128 美元（均值为 1295369 美元，四分位距为 267006 美元至 1503163 美元）。在校正了相关协变量后，公共保险公司占麻醉收入比例较大的医院更有可能向麻醉科团体支付直接款项（β=0.45；95%置信区间，0.10 至 0.81；P=0.013），因此，公共支付者所获得的麻醉收入比例每增加 10 个百分点，获得任何付款的概率就会增加 4.5 个百分点。在支付款项的医院中，我们的结果（β=2.10；95%置信区间，0.74 至 3.45；P=0.003）表明，公共支付者所获得的麻醉收入比例每增加 1 个百分点，支付金额就会相对增加 2%。