Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California.
Department of Radiation Medicine and Applied Sciences, University of California at San Diego, La Jolla, California.
Cancer. 2020 Oct 15;126(20):4584-4592. doi: 10.1002/cncr.33137. Epub 2020 Aug 11.
Pay-for-performance reimbursement ties hospital payments to standardized quality-of-care metrics. To the authors' knowledge, the impact of pay-for-performance reimbursement models on hospitals caring primarily for uninsured or underinsured patients remains poorly defined. The objective of the current study was to evaluate how standardized quality-of-care metrics vary by a hospital's propensity to care for uninsured or underinsured patients and demonstrate the potential impact that pay-for-performance reimbursement could have on hospitals caring for the underserved.
The authors identified 1,703,865 patients with cancer who were diagnosed between 2004 and 2015 and treated at 1344 hospitals. Hospital safety-net burden was defined as the percentage of uninsured or Medicaid patients cared for by that hospital, categorizing hospitals into low-burden, medium-burden, and high-burden hospitals. The authors evaluated the impact of safety-net burden on concordance with 20 standardized quality-of-care measures, adjusting for differences in patient age, sex, stage of disease at diagnosis, and comorbidity.
Patients who were treated at high-burden hospitals were more likely to be young, male, Black and/or Hispanic, and to reside in a low-income and low-educated region. High-burden hospitals had lower adherence to 13 of 20 quality measures compared with low-burden hospitals (all P < .05). Among the 350 high-burden hospitals, concordance with quality measures was found to be lowest for those caring for the highest percentage of uninsured or Medicaid patients, minority patients, and less educated patients (all P < .001).
Hospitals caring for uninsured or underinsured individuals have decreased quality-of-care measures. Under pay-for-performance reimbursement models, these lower quality-of-care scores could decrease hospital payments, potentially increasing health disparities for at-risk patients with cancer.
按绩效付费的报销方式将医院的支付与标准化的医疗质量指标挂钩。据作者所知，按绩效付费报销模式对主要为无保险或保险不足的患者提供服务的医院的影响仍未得到明确界定。本研究的目的是评估医院对无保险或保险不足患者的照顾倾向如何影响标准化的医疗质量指标，并展示按绩效付费报销模式对服务不足的患者的医院可能产生的影响。
作者确定了 1703865 名 2004 年至 2015 年间被诊断为癌症并在 1344 家医院接受治疗的患者。医院的安全网负担定义为该医院照顾的无保险或医疗补助患者的百分比，将医院分为低负担、中负担和高负担医院。作者评估了安全网负担对 20 项标准化医疗质量措施的一致性的影响，同时考虑了患者年龄、性别、诊断时疾病分期和合并症的差异。
在高负担医院接受治疗的患者更年轻、男性、黑人和/或西班牙裔，居住在低收入和低教育程度的地区。与低负担医院相比，高负担医院有 13 项质量指标的达标率较低（均 P <.05）。在 350 家高负担医院中，对于那些照顾最高比例的无保险或医疗补助患者、少数民族患者和受教育程度较低的患者，质量措施的一致性最低（均 P <.001）。
为无保险或保险不足的个人提供服务的医院的医疗质量措施较低。在按绩效付费报销模式下，这些较低的医疗质量评分可能会降低医院的支付，从而可能增加癌症高危患者的健康差距。
