Piri Saeed
Department of Operations and Business Analytics, Lundquist College of Business, University of Oregon, Eugene, OR, 97403, USA.
Eur J Health Econ. 2024 Mar;25(2):221-236. doi: 10.1007/s10198-023-01582-x. Epub 2023 Mar 26.
This paper focuses on Medicare's End-Stage Renal Disease Quality Incentive Program (QIP). QIP aims to promote high-quality services in outpatient dialysis facilities by tying their payments to their performance on pre-specified quality measures. In this paper, employing principal-agent theory, we examine the effectiveness of QIP by exploring the changes in various clinical/operational measures when they become a part of the program as a performance measure. We study five QIP quality measures; two are operational: hospitalization and readmission. And three others are clinical: blood transfusion, hypercalcemia, and dialysis adequacy. Overall, we observe a significant improvement in all QIP quality measures after being included in the program, except for readmission. We recommend adjusting the weight and redesigning the readmission measure for Medicare to incentivize providers to reduce readmission. We also discuss establishing care coordination and employing data-driven clinical decision support systems as opportunities for dialysis facilities to improve the care delivery process.
本文聚焦于医疗保险的终末期肾病质量激励计划（QIP）。QIP旨在通过将门诊透析设施的支付与它们在预先指定的质量指标上的表现挂钩，来促进高质量服务。在本文中，我们运用委托代理理论，通过探究各种临床/运营指标在成为该计划的绩效指标时的变化，来检验QIP的有效性。我们研究了五项QIP质量指标；其中两项是运营指标：住院率和再入院率。另外三项是临床指标：输血、高钙血症和透析充分性。总体而言，我们观察到所有QIP质量指标在被纳入该计划后都有显著改善，但再入院率除外。我们建议调整权重并重新设计医疗保险的再入院指标，以激励医疗服务提供者降低再入院率。我们还讨论了建立护理协调以及采用数据驱动的临床决策支持系统，将其作为透析设施改善护理提供过程的契机。
