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为什么我们在急诊医学中需要质量指标?

Why do we need quality measures in emergency medicine?

作者信息

Das Shamie, Miller Gregg, Libby Christopher, Gettel Cameron J, Rabin Elaine, Lin Michelle

机构信息

Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA.

Vituity Emeryville California USA.

出版信息

J Am Coll Emerg Physicians Open. 2024 Dec 17;5(6):e13329. doi: 10.1002/emp2.13329. eCollection 2024 Dec.

DOI:10.1002/emp2.13329
PMID:39697807
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11652395/
Abstract

Quality measures increasingly influence the delivery and reimbursement of care provided in emergency departments. While emergency physicians are accustomed to using quality measures to improve care delivery, payors, including the Centers for Medicare and Medicaid Services (CMS), are increasingly adjusting reimbursement to measure performance as a means to bend the cost curve and improve the value of healthcare services. The American College of Emergency Physicians Quality and Patient Safety Committee presents this whitepaper to guide practicing emergency physicians through the policy context of implementing measures in emergency care and understanding its impact reimbursement. This paper summarizes current CMS programs such as the merit-based incentive payment system (MIPS), MIPS value pathways, and alternative payment models and various reporting mechanisms. It is crucial for emergency physicians to understand the quality measure development process, the need for more emergency medicine-specific quality measures, and the growing significance of measure performance in the payment of emergency care.

摘要

质量指标越来越多地影响着急诊科所提供护理的提供和报销。虽然急诊医生习惯于使用质量指标来改善护理服务,但包括医疗保险和医疗补助服务中心(CMS)在内的付款方越来越多地调整报销,以衡量绩效,作为控制成本曲线和提高医疗服务价值的一种手段。美国急诊医师学会质量与患者安全委员会发布本白皮书,以指导执业急诊医生了解在急诊护理中实施指标的政策背景,并理解其对报销的影响。本文总结了当前的CMS计划,如基于绩效的激励支付系统(MIPS)、MIPS价值路径和替代支付模式以及各种报告机制。急诊医生了解质量指标的制定过程、对更多针对急诊医学的质量指标的需求以及指标绩效在急诊护理支付中的日益重要性至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/24d0/11652395/3adda1bbacf4/EMP2-5-e13329-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/24d0/11652395/8c30b213fbc3/EMP2-5-e13329-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/24d0/11652395/48da607977c5/EMP2-5-e13329-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/24d0/11652395/3adda1bbacf4/EMP2-5-e13329-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/24d0/11652395/8c30b213fbc3/EMP2-5-e13329-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/24d0/11652395/48da607977c5/EMP2-5-e13329-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/24d0/11652395/3adda1bbacf4/EMP2-5-e13329-g002.jpg

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本文引用的文献

1
The future of value-based emergency care: Development of an emergency medicine MIPS value pathway framework.基于价值的急诊护理的未来:急诊医学MIPS价值路径框架的开发。
J Am Coll Emerg Physicians Open. 2022 Mar 12;3(2):e12672. doi: 10.1002/emp2.12672. eCollection 2022 Apr.
2
The 2018 Merit-based Incentive Payment System: Participation, Performance, and Payment Across Specialties.2018 年基于绩效的激励支付系统:各专业的参与、绩效和支付。
Med Care. 2022 Feb 1;60(2):156-163. doi: 10.1097/MLR.0000000000001674.
3
How to fix the Merit-based Incentive Payment System (MIPS) in emergency medicine.
如何修复急诊医学中的基于绩效的激励支付系统(MIPS)。
Acad Emerg Med. 2022 Jan;29(1):128-130. doi: 10.1111/acem.14371. Epub 2021 Aug 26.
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The Costs of US Emergency Department Visits.美国急诊科就诊的费用。
JAMA. 2021 Jan 26;325(4):333. doi: 10.1001/jama.2020.26936.
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Getting The Price Right: How Some Countries Control Spending In A Fee-For-Service System.定价合理:一些国家如何在按服务收费体系中控制支出
Health Aff (Millwood). 2020 Nov;39(11):1867-1874. doi: 10.1377/hlthaff.2019.01804.
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The Incompatibility of Patient-Centered Care With Fee-for-Service Payment.以患者为中心的护理与按服务收费支付方式的不相容性。
JAMA Intern Med. 2020 Dec 1;180(12):1572-1573. doi: 10.1001/jamainternmed.2020.4341.
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How The ACA Dented The Cost Curve.《平价医疗法案》如何抑制成本曲线。
Health Aff (Millwood). 2020 Mar;39(3):403-412. doi: 10.1377/hlthaff.2019.01478.
8
Effect of Accountable Care Organizations on Emergency Medicine Payment and Care Redesign: A Qualitative Study.责任医疗组织对急诊医疗支付和医疗服务设计的影响:一项定性研究。
Ann Emerg Med. 2020 May;75(5):597-608. doi: 10.1016/j.annemergmed.2019.09.010. Epub 2020 Jan 20.
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The Role Of Social Risk Factors In Dialysis Facility Ratings And Penalties Under A Medicare Quality Incentive Program.社会风险因素在医疗保险质量激励计划下的透析机构评级和处罚中的作用。
Health Aff (Millwood). 2019 Jul;38(7):1101-1109. doi: 10.1377/hlthaff.2018.05406.
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Consensus Development of a Modern Ontology of Emergency Department Presenting Problems-The Hierarchical Presenting Problem Ontology (HaPPy).急诊就诊问题现代本体论共识的发展——分层就诊问题本体论(HaPPy)。
Appl Clin Inform. 2019 May;10(3):409-420. doi: 10.1055/s-0039-1691842. Epub 2019 Jun 12.