University of Alabama at Birmingham, Birmingham, AL, USA.
Virginia Commonwealth University, Richmond, VA, USA.
Med Care Res Rev. 2021 Oct;78(5):598-606. doi: 10.1177/1077558720927586. Epub 2020 Jun 17.
The Medicare value-based purchasing (VBP) program, ongoing since 2013, uses financial bonuses and penalties to incentivize hospital quality improvements. Previous research has identified characteristics of penalized hospitals, but has not examined characteristics of hospitals with improvements in VBP program performance or consistent good performance. We identify five different trajectories of program performance (improvement, decline, consistent good or poor performance, mixed). A total of 11% of hospitals were penalized every year of the program, 24% improved their VBP program performance, 14% of hospitals consistently earned a bonus, while 18% performed well in the program's early years but experienced declines in performance. In 2013, organizational and community characteristics were associated with higher odds of improving relative to performing poorly every year. Few variables under managers' control were associated with program improvement, though accountable care organization participation was in some models. We find changes in VBP program metrics may have contributed to improvement in some hospitals' program scores.
自 2013 年以来，医疗保险基于价值的采购（VBP）计划一直在使用财务奖励和惩罚来激励医院提高质量。之前的研究已经确定了受惩罚医院的特征，但没有研究 VBP 计划绩效改善或持续良好表现的医院的特征。我们确定了计划绩效的五种不同轨迹（改善、下降、持续良好或较差表现、混合）。在该计划的每一年中，总共有 11%的医院受到惩罚，24%的医院改善了 VBP 计划的绩效，14%的医院始终获得奖金，而 18%的医院在计划的早期表现良好，但绩效下降。2013 年，组织和社区特征与每年表现不佳相比，提高的可能性更高。虽然一些模型中参与问责医疗组织（accountable care organization）与计划改进有关，但管理者控制下的很少变量与计划改进有关。我们发现 VBP 计划指标的变化可能导致一些医院的计划得分提高。
