{"title":"心脏病医院,医疗保险和交叉补贴。","authors":"Thomas R McLean, Valerie Lawson","doi":"10.15420/ahhj.2009.7.2.94","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Compared with heart hospitals (HHs), does Medicare provide better reimbursement to traditional hospitals (THs)?</p><p><strong>Methods: </strong>Diagnosis Related Group (DRG)-specific data from Hospital Compare (www.hospitalcompare.hhs.gov) were used to compare Medicare reimbursement to hospitals in nine HH markets, representing 10% of the national HH market.</p><p><strong>Results: </strong>On average, markets contained 1.2 HHs and 8.1 THs. Average market size for invasive cardiac services was $13+/-8.4 million, with HHs having 36.1% of the market share. Compared with HHs, THs received significantly better reimbursement for coronary artery bypass graft (CABG: $20,281+/-3,047 HH versus $23,958+/-4,562 TH; p=0.004), percutaneous coronary intervention (PCI: $11,230+/-742 HH versus $13,347+/-2,662 TH; p<0.001), heart valve replacement ($33,710+/-4,056 HH versus $39,819+/-6,356 TH; p=0.001), pacemaker implantation ($11,245+/-706 HH versus $13,212+/-2,043 TH; p<0.001), heart failure ($5,622+/-489 HH versus $6,482+/-1,010 TH; p<0.001), chronic obstructive pulmonary disease (COPD: $4,893+/-802 HH versus $5,641+/-841 TH; p=0.013), pneumonia ($5,708+/-763 HH versus $6,456+/-1,136 TH; p=0.012), and diabetes ($4,115+/-355 HH versus $4,963+/-812 TH; p<0.001).</p><p><strong>Conclusions: </strong>The excessive reimbursement granted to THs for non-cardiac services is likely to reflect a policy decision to assist these hospitals with their cross-subsidization of other services. If Medicare is to cut reimbursement to TH for CABG, PCI, or other services, Medicare should be asked to pay more for the services (e.g. emergency room care) that it currently reimburses only indirectly through the process of cross-subsidization.</p>","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 2","pages":"E94-8"},"PeriodicalIF":0.0000,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Heart hospitals, medicare, and cross-subsidization.\",\"authors\":\"Thomas R McLean, Valerie Lawson\",\"doi\":\"10.15420/ahhj.2009.7.2.94\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Compared with heart hospitals (HHs), does Medicare provide better reimbursement to traditional hospitals (THs)?</p><p><strong>Methods: </strong>Diagnosis Related Group (DRG)-specific data from Hospital Compare (www.hospitalcompare.hhs.gov) were used to compare Medicare reimbursement to hospitals in nine HH markets, representing 10% of the national HH market.</p><p><strong>Results: </strong>On average, markets contained 1.2 HHs and 8.1 THs. Average market size for invasive cardiac services was $13+/-8.4 million, with HHs having 36.1% of the market share. Compared with HHs, THs received significantly better reimbursement for coronary artery bypass graft (CABG: $20,281+/-3,047 HH versus $23,958+/-4,562 TH; p=0.004), percutaneous coronary intervention (PCI: $11,230+/-742 HH versus $13,347+/-2,662 TH; p<0.001), heart valve replacement ($33,710+/-4,056 HH versus $39,819+/-6,356 TH; p=0.001), pacemaker implantation ($11,245+/-706 HH versus $13,212+/-2,043 TH; p<0.001), heart failure ($5,622+/-489 HH versus $6,482+/-1,010 TH; p<0.001), chronic obstructive pulmonary disease (COPD: $4,893+/-802 HH versus $5,641+/-841 TH; p=0.013), pneumonia ($5,708+/-763 HH versus $6,456+/-1,136 TH; p=0.012), and diabetes ($4,115+/-355 HH versus $4,963+/-812 TH; p<0.001).</p><p><strong>Conclusions: </strong>The excessive reimbursement granted to THs for non-cardiac services is likely to reflect a policy decision to assist these hospitals with their cross-subsidization of other services. If Medicare is to cut reimbursement to TH for CABG, PCI, or other services, Medicare should be asked to pay more for the services (e.g. emergency room care) that it currently reimburses only indirectly through the process of cross-subsidization.</p>\",\"PeriodicalId\":87149,\"journal\":{\"name\":\"The American heart hospital journal\",\"volume\":\"7 2\",\"pages\":\"E94-8\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2009-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The American heart hospital journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.15420/ahhj.2009.7.2.94\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The American heart hospital journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15420/ahhj.2009.7.2.94","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2
摘要
背景:与心脏病医院(HHs)相比,医疗保险是否为传统医院(THs)提供了更好的报销?方法:使用来自Hospital Compare (www.hospitalcompare.hhs.gov)的诊断相关组(DRG)特定数据来比较9个医疗保健市场(占全国医疗保健市场的10%)的医疗保险报销。结果:市场平均包含1.2个HHs和8.1个THs。侵入性心脏服务的平均市场规模为1340万美元/- 840万美元,HHs占有36.1%的市场份额。与HHs相比,THs获得了更好的冠状动脉旁路移植术报销(CABG: $20,281+/-3,047 HH vs $23,958+/-4,562 TH;p=0.004),经皮冠状动脉介入治疗(PCI: 11,230+/-742 HH vs 13,347+/-2,662 TH;结论:此类医院在非心脏服务方面的过度报销可能反映了一项政策决定,即帮助这些医院对其他服务进行交叉补贴。如果联邦医疗保险计划削减对CABG、PCI或其他服务的TH报销,则应要求联邦医疗保险计划为目前仅通过交叉补贴过程间接报销的服务(例如急诊室护理)支付更多费用。
Heart hospitals, medicare, and cross-subsidization.
Background: Compared with heart hospitals (HHs), does Medicare provide better reimbursement to traditional hospitals (THs)?
Methods: Diagnosis Related Group (DRG)-specific data from Hospital Compare (www.hospitalcompare.hhs.gov) were used to compare Medicare reimbursement to hospitals in nine HH markets, representing 10% of the national HH market.
Results: On average, markets contained 1.2 HHs and 8.1 THs. Average market size for invasive cardiac services was $13+/-8.4 million, with HHs having 36.1% of the market share. Compared with HHs, THs received significantly better reimbursement for coronary artery bypass graft (CABG: $20,281+/-3,047 HH versus $23,958+/-4,562 TH; p=0.004), percutaneous coronary intervention (PCI: $11,230+/-742 HH versus $13,347+/-2,662 TH; p<0.001), heart valve replacement ($33,710+/-4,056 HH versus $39,819+/-6,356 TH; p=0.001), pacemaker implantation ($11,245+/-706 HH versus $13,212+/-2,043 TH; p<0.001), heart failure ($5,622+/-489 HH versus $6,482+/-1,010 TH; p<0.001), chronic obstructive pulmonary disease (COPD: $4,893+/-802 HH versus $5,641+/-841 TH; p=0.013), pneumonia ($5,708+/-763 HH versus $6,456+/-1,136 TH; p=0.012), and diabetes ($4,115+/-355 HH versus $4,963+/-812 TH; p<0.001).
Conclusions: The excessive reimbursement granted to THs for non-cardiac services is likely to reflect a policy decision to assist these hospitals with their cross-subsidization of other services. If Medicare is to cut reimbursement to TH for CABG, PCI, or other services, Medicare should be asked to pay more for the services (e.g. emergency room care) that it currently reimburses only indirectly through the process of cross-subsidization.