专科医生薪酬与责任医疗组织绩效的关联。

Association between specialist compensation and Accountable Care Organization performance.

机构信息

Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.

Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.

出版信息

Health Serv Res. 2020 Oct;55(5):722-728. doi: 10.1111/1475-6773.13323. Epub 2020 Jul 27.

DOI:10.1111/1475-6773.13323

PMID:32715464

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7518824/

Abstract

OBJECTIVE

To determine if Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance.

DATA SOURCES

National, cross-sectional survey data on ACOs (2013-2015) linked to public-use data on ACO performance (2014-2016).

STUDY DESIGN

We compared characteristics of ACOs that did and did not report use of cost reduction measures in specialist compensation and determined the association between using this approach and ACO savings, outpatient spending, and specialist visit rates.

PRINCIPAL FINDINGS

Of 160 ACOs surveyed, 26 percent reported using cost reduction measures to help determine specialist compensation. ACOs using cost reduction in specialist compensation were more often physician-led (68.3 vs 49.6 percent) and served higher-risk patients (mean Hierarchical Condition Category score 1.09 vs 1.05). These ACOs had similar savings per beneficiary year (adjusted difference $82.6 [95% CI -77.9, 243.1]), outpatient spending per beneficiary year (-24.0 [95% CI -248.9, 200.8]), and specialist visits per 1000 beneficiary years (369.7 [95% CI -9.3, 748.7]).

CONCLUSION

Incentivizing specialists on cost reduction was not associated with ACO savings in the short term. Further work is needed to determine the most effective approach to engage specialists in ACO efforts.

摘要

目的

确定医疗保险共享储蓄计划责任医疗组织（ACO）在专家薪酬中使用降低成本措施是否表现更好。

数据来源

与 ACO 绩效的公共使用数据（2014-2016 年）相关联的全国性、横截面调查数据（2013-2015 年）。

研究设计

我们比较了报告和未报告在专家薪酬中使用降低成本措施的 ACO 的特征，并确定了采用这种方法与 ACO 储蓄、门诊支出和专家就诊率之间的关联。

主要发现

在接受调查的 160 个 ACO 中，26%报告使用降低成本措施来帮助确定专家薪酬。在专家薪酬中使用成本降低措施的 ACO 更可能由医生领导（68.3%比 49.6%），并为高风险患者提供服务（平均层次条件类别评分 1.09 比 1.05）。这些 ACO 的每个受益年度的储蓄额相似（调整后的差异为 82.6 美元[95%CI-77.9，243.1]），每个受益年度的门诊支出（-24.0 美元[95%CI-248.9，200.8]）和每 1000 个受益年度的专家就诊次数（369.7 美元[95%CI-9.3，748.7]）。