RAND Health Care, RAND Corporation, Boston, Massachusetts, USA.
RAND Health Care, RAND Corporation, Santa Monica, California, USA.
Health Serv Res. 2023 Feb;58(1):91-100. doi: 10.1111/1475-6773.14040. Epub 2022 Aug 9.
To determine if increases in hospital discharge prices are associated with improvements in clinical quality or patient experience.
This study used Medicare cost report data and publicly available Medicare.gov Care Compare quality measures for approximately 3000 short-term care general hospitals between 2011 and 2018.
We separately regressed quality measure scores on a lag of case mix adjusted discharge price, hospital fixed effects, and year indicators. Clinical quality measures included 30-day readmission rates for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, hip and knee replacement, and pneumonia; risk-adjusted 30-day mortality rates for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, and stroke; and 90-day complication rate for hip and knee replacement. Patient experience measures included the summary star rating and 10 domain measures reported through the Hospital Consumer Assessment of Healthcare Providers and Systems survey. We tested for heterogeneous effects by hospital ownership, number of beds, the commercial share of overall discharges, and market concentration.
DATA COLLECTION/EXTRACTION METHODS: We linked hospitals identified in Medicare cost reports to Medicare.gov Care Compare quality measures. We excluded hospitals for which we could not identify a discharge price or that had an unrealistic price.
There was no positive association between lagged discharge price and any clinical quality measure. For patient experience measures, a 2% increase in discharge price was not associated with overall patient satisfaction but was associated with small, statistically significant increases ranging from 0.01% to 0.02% (relative to mean scores) for seven of ten domain measures. There was a positive association for five of ten patient experience measures in competitive markets and one measure in both moderately concentrated and heavily concentrated markets.
We found no evidence that hospitals use higher prices to make investments in clinical quality; patient experience improved, but only negligibly.
确定医院出院价格的上涨是否与临床质量或患者体验的改善有关。
本研究使用了医疗保险成本报告数据和 Medicare.gov 护理比较中大约 3000 家短期护理综合医院在 2011 年至 2018 年期间的公开可用的医疗保险质量指标。
我们分别将质量指标得分与滞后的病例组合调整后的出院价格、医院固定效应和年份指标进行回归。临床质量指标包括急性心肌梗死、慢性阻塞性肺疾病、心力衰竭、髋关节和膝关节置换以及肺炎的 30 天再入院率；急性心肌梗死、慢性阻塞性肺疾病、心力衰竭和中风的风险调整后 30 天死亡率；髋关节和膝关节置换的 90 天并发症率。患者体验指标包括通过医院消费者评估医疗保健提供者和系统调查报告的综合星级评分和 10 个领域指标。我们通过医院所有权、床位数量、整体出院人数的商业份额和市场集中程度测试了异质效应。
数据收集/提取方法：我们将医疗保险成本报告中确定的医院与 Medicare.gov 护理比较质量指标相关联。我们排除了无法确定出院价格或价格不切实际的医院。
滞后的出院价格与任何临床质量指标之间没有正相关关系。对于患者体验指标，出院价格上涨 2%与整体患者满意度无关，但与十个领域指标中的七个指标的小而显著的增长相关，增长幅度在 0.01%至 0.02%之间（相对于平均分数）。在竞争市场中，有五个患者体验指标呈正相关，在中度集中和高度集中的市场中，有一个指标呈正相关。
我们没有发现医院利用更高的价格来投资临床质量的证据；患者体验有所改善，但微不足道。
