Ramirez Adriana G, Marsh Katherine M, McMurry Timothy L, Turrentine Florence E, Tracci Margaret A, Jones Rayford S
J Healthc Qual. 2022;44(2):78-87. doi: 10.1097/JHQ.0000000000000321.
The Medicare Value-Based Purchasing (VBP) program established performance-based financial incentives for hospitals. We hypothesized that total performance scores (TPS) would vary by hospital type.
Value-Based Purchasing reports were collected from 2015 to 2017 and merged with the Centers for Medicare and Medicaid Services (CMS) Impact File data. A total of 3,005 hospitals were grouped into physician-owned surgical hospitals (POSH), accountable care organizations (ACO), Kaiser, Vizient, and General hospitals. Longitudinal linear mixed-effects models compared temporal differences of TPS and secondary composite outcome, process, patient satisfaction, safety, and cost efficiency measures between hospital types.
Total performance scores decreased across all hospital types (p < .001). Physician-owned surgical hospitals had the highest TPS (59.9), followed by Kaiser (49.2), ACO (36.7), General (34.8), and Vizient (30.7) (p < .001). Hospital types differed significantly in size, geography, mean case-mix index, Medicare patient discharges, percent Medicare days to inpatient days, Disproportionate Share Hospital payments, and uncompensated care per claim. Scores improved in 84% of POSH and 14.6% of Kaiser hospitals using score reallocations.
In comparison with General hospitals, the TPS was higher for POSH and Kaiser and lower for Vizient in part due to weighting reallocation and individual domain scores.
Centers for Medicare and Medicaid Services scoring system changes have not addressed the methodological biases favoring certain hospital types.
医疗保险基于价值的购买（VBP）计划为医院设立了基于绩效的财务激励措施。我们假设总体绩效得分（TPS）会因医院类型而异。
收集了2015年至2017年基于价值购买的报告，并与医疗保险和医疗补助服务中心（CMS）影响文件数据合并。总共3005家医院被分为医生拥有的外科医院（POSH）、 accountable care organizations（ACO）、凯撒医疗机构、维兹安特医疗机构和综合医院。纵向线性混合效应模型比较了不同医院类型之间TPS以及二级综合结果、流程、患者满意度、安全性和成本效率指标的时间差异。
所有医院类型的总体绩效得分均下降（p <.001）。医生拥有的外科医院TPS最高（59.9），其次是凯撒医疗机构（49.2）、ACO（36.7）、综合医院（34.8）和维兹安特医疗机构（30.7）（p <.001）。不同医院类型在规模、地理位置、平均病例组合指数、医疗保险患者出院人数、医疗保险天数占住院天数的百分比、不成比例份额医院支付以及每项索赔的无偿护理方面存在显著差异。使用得分重新分配后，84%的POSH医院和14.6%的凯撒医疗机构得分有所提高。
与综合医院相比，POSH和凯撒医疗机构的TPS较高，而维兹安特医疗机构的TPS较低，部分原因是权重重新分配和各个领域得分。
医疗保险和医疗补助服务中心的评分系统变化并未解决有利于某些医院类型的方法学偏差。
