Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY.
Icahn School of Medicine at Mount Sinai, New York, NY.
J Arthroplasty. 2021 Mar;36(3):801-809. doi: 10.1016/j.arth.2020.10.007. Epub 2020 Oct 12.
Under bundled payment models, gainsharing presents an important mechanism to ensure engagement and reward innovation. We hypothesized that metric selection, metric targets, and risk adjustment would impact surgeons' performance in gainsharing models.
Patients undergoing total joint arthroplasty at an urban health system from 2017 to September 2018 were included. Gainsharing metrics included the following: length of stay, % discharge-to-home, 90-day readmission rate, % of patients with episode spend under target price, and % of patients with patient-reported outcomes (PROs) collected. Four scenarios were created to evaluate how metric selection/adjustment impacted surgeons' performance designation: scenario 1 used "aspirational targets" (>60th percentile), scenario 2 used "acceptable targets" (>50th percentile), scenario 3 risk-adjusted surgeon performance prior to comparing aspirational targets, and scenario 4 included a PRO collection metric. Number of metrics achieved determined performance tier, with higher tiers getting a greater share of the gainsharing pool.
In total, 2776 patients treated by 12 surgeons met inclusion criteria (mean length of stay 3.0 days, readmission rate 4.0%, discharge-to-home 74%, episode spend under target price 85%, PRO collection 56%). Lowering of metric targets (scenario 1 vs. 2) resulted in a 75% increase in the number of high performers and 98% of the gainsharing pool being eligible for distribution. Risk adjustment (scenario 3) caused 50% of providers to move to higher performance tiers and potential payments to increase by 28%. Adding the PRO metric did not change performance.
Quality metric/target selection and risk adjustment profoundly impact surgeons' performance in gainsharing contracts. This impacts how successful these contracts can be in driving innovation and dis-incentivizing the "cherry picking" of patients.
Level III.
在捆绑式支付模式下，收益共享提供了一种确保参与和奖励创新的重要机制。我们假设指标选择、指标目标和风险调整会影响外科医生在收益共享模式中的表现。
本研究纳入了 2017 年至 2018 年 9 月在一个城市卫生系统接受全关节置换术的患者。收益共享指标包括以下内容：住院时间、出院回家比例、90 天再入院率、目标价格下患者费用比例、患者报告结局（PROs）收集比例。创建了四个场景来评估指标选择/调整如何影响外科医生的绩效评定：场景 1 使用“理想目标”（>第 60 个百分位），场景 2 使用“可接受目标”（>第 50 个百分位），场景 3 在比较理想目标之前对外科医生的绩效进行风险调整，场景 4 包括 PRO 收集指标。实现的指标数量决定了绩效等级，较高的等级获得更多的收益共享池份额。
共有 12 名外科医生治疗的 2776 名患者符合纳入标准（平均住院时间 3.0 天，再入院率 4.0%，出院回家比例 74%，目标价格下的费用比例 85%，PRO 收集比例 56%）。降低指标目标（场景 1 与场景 2）导致高绩效者数量增加 75%，98%的收益共享池有资格分配。风险调整（场景 3）导致 50%的提供者进入更高的绩效等级，潜在支付增加 28%。添加 PRO 指标不会改变绩效。
质量指标/目标选择和风险调整对收益共享合同中外科医生的表现有深远影响。这会影响这些合同在推动创新和避免“择优选择”患者方面的成功程度。
III 级。
