Karim Saleema A, Nevola Adrienne, Morris Michael E, Tilford J Mick, Chen Hsueh-Fen
Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Rural Health. 2021 Mar;37(2):296-307. doi: 10.1111/jrh.12475. Epub 2020 Jul 2.
The Hospital Readmission and Reduction Program (HRRP) and Hospital Value-Based Purchasing Program (HVBP) propose to improve quality of patient care by either rewarding or penalizing hospitals through inpatient reimbursement. This study analyzes the effect of both programs on profitability of hospitals located in the Appalachian Region (AR) compared to hospitals in Appalachian states and the rest of the United States.
This study used a retrospective research design with a longitudinal unbalanced panel dataset from 2008 to 2015. Hospitals participating in both HRRP and HVBP during this time frame were included in the study. A difference-in-difference model with hospital-level fixed effects, controlling for hospital and market characteristics, was used to determine effects of both programs on profitability of hospitals serving the AR, Appalachian states, and the rest of the United States.
After implementation of HRRP and HVBP, only hospitals located in Appalachian states experienced a significant decrease in operating margin (-1.14 percentage points). Unexpectedly, during the same time period, total margin increased significantly for hospitals located in the AR (1.05 percentage points), Appalachian states (1.71 percentage points), and the rest of the United States (2.38 percentage points).
HRRP and HVBP financially incentivize hospitals to focus efforts on improving patient care. The programs may not have the anticipated results. Increases in total margin for all hospitals during the study period indicate access to nonpatient revenues, offsetting the financial penalties from both programs. This revenue source may undermine the program's objectives of delivering value and achieving quality outcomes.
医院再入院及降低计划（HRRP）和医院基于价值的采购计划（HVBP）提议通过住院报销对医院进行奖惩，以提高患者护理质量。本研究分析了这两个计划对阿巴拉契亚地区（AR）医院盈利能力的影响，并与阿巴拉契亚州及美国其他地区的医院进行比较。
本研究采用回顾性研究设计，使用了2008年至2015年的纵向不平衡面板数据集。研究纳入了在此期间同时参与HRRP和HVBP的医院。采用具有医院层面固定效应的双重差分模型，控制医院和市场特征，以确定这两个计划对服务于AR、阿巴拉契亚州及美国其他地区医院盈利能力的影响。
实施HRRP和HVBP后，只有位于阿巴拉契亚州的医院营业利润率显著下降（-1.14个百分点）。出乎意料的是，在同一时期，位于AR的医院总利润率显著上升（1.05个百分点），阿巴拉契亚州的医院（1.71个百分点）以及美国其他地区的医院（2.38个百分点）也是如此。
HRRP和HVBP在经济上激励医院将精力集中在改善患者护理上。这些计划可能没有达到预期效果。研究期间所有医院总利润率的增加表明获得了非患者收入，抵消了这两个计划的经济处罚。这种收入来源可能会破坏该计划实现价值和取得质量成果的目标。
