Charles N. Kahn III, Federation of American Hospitals, Washington, D.C.
Kimberly Rhodes (
Health Aff (Millwood). 2023 Jul;42(7):928-936. doi: 10.1377/hlthaff.2022.00844.
Several Centers for Medicare and Medicaid Services (CMS) programs aim to transform how health care is delivered by adjusting Medicare inpatient hospital payments through a system of rewards and penalties based on performance on measures of quality. These programs are the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program. We analyzed value-based program penalty results for various groups of hospitals across these three programs and assessed the impact of patient and community health equity risk factors on hospital penalties. We found statistically significant positive relationships between hospital penalties and several factors that affect hospital performance but that hospitals cannot control-namely, medical complexity (as measured by Hierarchical Condition Categories scores), uncompensated care, and the portion of hospital catchment area populations who live alone. Moreover, these environmental conditions can be worse for hospitals that operate in areas with historically underserved populations. This suggests that the CMS programs might not adequately account for health equity factors at the community level. Refinements to these programs (including an explicit incorporation of patient and community health equity risk factors) and continued monitoring will help ensure that the programs work as intended in a fair and equitable fashion.
几个医疗保险和医疗补助服务中心（CMS）的项目旨在通过基于质量衡量标准的绩效奖励和惩罚制度，调整医疗保险住院病人的支付方式，从而改变医疗服务的提供方式。这些项目包括住院病人再入院率降低计划、医院价值购买计划和医院获得性条件降低计划。我们分析了这三个项目中不同医院群体的基于价值的项目惩罚结果，并评估了患者和社区健康公平风险因素对医院惩罚的影响。我们发现医院惩罚与几个影响医院绩效但医院无法控制的因素之间存在显著的正相关关系，这些因素包括医疗复杂性（由层次条件类别评分衡量）、无补偿护理和医院服务区域内独居人口的比例。此外，这些环境条件对在历史上服务不足的人群中运营的医院来说可能更糟。这表明，CMS 项目可能没有充分考虑社区层面的健康公平因素。对这些项目进行改进（包括明确纳入患者和社区健康公平风险因素）和持续监测，将有助于确保这些项目以公平和公正的方式按预期运作。
