Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Department of Economics, University of Michigan, Ann Arbor, Michigan, USA.
Med Decis Making. 2022 Jan;42(1):51-59. doi: 10.1177/0272989X211017105. Epub 2021 May 27.
Medicare's Hospital Value-Based Purchasing Program (HVBP) is the first national pay-for-performance program to combine measures of quality of care with a measure of episode spending. We estimated the implicit tradeoffs between mortality reduction and spending reduction. To earn points in HVBP, a hospital can either lower mortality or reduce spending, creating a tradeoff between the 2 measures. We analyzed the quality performance and earned points of 2814 hospitals using publicly available data. We then quantified the tradeoffs between spending and mortality in terms of quality-adjusted life-years (QALYs). If incentives in the program were balanced, then the tradeoff between spending and QALYs should be comparable with those of high-value health interventions, roughly $50,000 to $200,000 per QALY. Instead, the tradeoff in HVBP was about $1.2 million per QALY. HVBP overvalues improvements in quality of care relative to spending reductions. We propose 2 possible policy adjustments that could improve incentives for hospitals to deliver high-value care.
医疗保险的医院价值采购计划（HVBP）是第一个将护理质量措施与疾病支出措施相结合的全国按绩效付费计划。我们估计了死亡率降低和支出减少之间的隐含权衡。为了在 HVBP 中获得积分，医院可以降低死亡率或降低支出，从而在这两个措施之间进行权衡。我们使用公开数据分析了 2814 家医院的质量绩效和获得的积分。然后，我们根据质量调整生命年（QALY）来量化支出和死亡率之间的权衡。如果该计划中的激励措施平衡，那么支出和 QALY 之间的权衡应该与高价值健康干预措施相当，大约为每 QALY5 万美元至 20 万美元。相反，HVBP 中的权衡约为每 QALY120 万美元。HVBP 高估了相对于支出减少的护理质量改善。我们提出了 2 种可能的政策调整，这可以改善医院提供高价值护理的激励措施。
