基准如何影响问责制医疗组织的参与:自愿支付模式的前景

IF 2 2区 经济学 Q1 ECONOMICS
American Journal of Health Economics Pub Date : 2025-01-01 Epub Date: 2024-12-17 DOI:10.1086/726748
Alice J Chen, J Michael McWilliams
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引用次数: 0

摘要

在自愿替代支付模式中,参与对于模式的可行性和提供者支付改革的进展至关重要。我们研究负责任的医疗机构(ACOs)在医疗保险共享储蓄计划(MSSP)的参与决策。我们利用了一个自然实验,在这个实验中,2017年的规则变化对ACO的基准支出和绩效年支出带来了不同的冲击。净效应是不同aco之间基准的有效变化。在有效基准下降的aco中,退学的可能性增加了7个百分点。虽然有效基准的小幅度下降不会影响项目参与率,但大幅度下降使辍学率上升了11个百分点。支出已经高于基准的ACOs对有效的基准削减尤其敏感,这与该计划削减支出的长期激励不力相一致。我们的研究结果强调了基准在决定ACO参与方面的因果作用,以及在设计新支付模式时考虑参与效应后果的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How Benchmark Changes Affect Participation in Accountable Care Organizations: Prospects for Voluntary Payment Models.

In voluntary alternative payment models, participation is essential for model viability and the progression of provider payment reform. We study participation decisions of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). We leverage a natural experiment in which a 2017 rule change introduced differential shocks to an ACO's baseline spending and performance-year spending. The net effect was an effective change in benchmarks that varied across ACOs. Dropout was 7 percentage points more likely among ACOs with effective benchmark decreases. While small reductions in the effective benchmark did not affect program participation, larger reductions increased dropout by 11 percentage points. ACOs with spending already above their benchmarks were particularly sensitive to effective benchmark reductions, consistent with the program's weak long-term incentives to reduce spending. Our results highlight the causal role benchmarks play in determining ACO participation and the need to consider the consequences of participation effects in the design of new payment models.

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来源期刊
CiteScore
4.30
自引率
2.70%
发文量
34
期刊介绍: The American Journal of Health Economics (AJHE) provides a forum for the in-depth analysis of health care markets and individual health behaviors. The articles appearing in AJHE are authored by scholars from universities, private research organizations, government, and industry. Subjects of interest include competition among private insurers, hospitals, and physicians; impacts of public insurance programs, including the Affordable Care Act; pharmaceutical innovation and regulation; medical device supply; the rise of obesity and its consequences; the influence and growth of aging populations; and much more.
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