Achanta Aditya, Velasquez David E, Grabowski David C
Harvard Medical School, 4 Greenway Ct, Apt 1, Brookline, MA 02446. Email:
Am J Manag Care. 2021 Sep;27(9):369-371. doi: 10.37765/ajmc.2021.88739.
On November 25, 2020, CMS announced the creation of an Acute Hospital Care at Home program to reimburse qualifying hospital-at-home models. As we increasingly adopt the Acute Hospital Care at Home program and similar home-based services, it is crucial to better define the value of these programs and their appropriate reimbursement rates. We provide a framework centered around cost, quality, and equity to help accomplish this task. Quality reporting should use both inpatient-specific and home health care-specific metrics, equity-focused process metrics and risk-adjusted outcome metrics, and validated disease-specific tools. Costs should be measured comprehensively and uniformly through the use of time-driven activity-based costing and consider caregiver opportunity costs. It is also worthwhile to consider personal, societal, technical, and allocative value when determining the value and subsequent reimbursement rates of hospital-at-home programs. With careful patient selection, the hospital-at-home model has the potential to significantly benefit a subset of patients. To create sustainable reimbursement mechanisms for hospital-at-home programs, we first need a better definition of the value provided by this model of care.
2020年11月25日，美国医疗保险和医疗补助服务中心（CMS）宣布设立一项“居家急性医院护理”计划，以偿付符合条件的居家医院模式。随着我们越来越多地采用“居家急性医院护理”计划及类似的居家服务，更好地界定这些计划的价值及其适当的偿付率至关重要。我们提供了一个围绕成本、质量和公平性的框架，以帮助完成这项任务。质量报告应使用针对住院患者和居家医疗护理的特定指标、关注公平性的过程指标和风险调整后的结果指标，以及经过验证的特定疾病工具。成本应通过使用时间驱动作业成本法进行全面统一的衡量，并考虑护理人员的机会成本。在确定居家医院计划的价值和后续偿付率时，考虑个人、社会、技术和分配价值也是值得的。通过谨慎选择患者，居家医院模式有可能使一部分患者显著受益。为了建立居家医院计划的可持续偿付机制，我们首先需要更好地界定这种护理模式所提供的价值。
