Evaluation of Clinical and Economic Outcomes Following Implementation of a Medicare Pay-for-Performance Program for Surgical Procedures.
JAMA Netw Open
; 4(8): e2121115, 2021 08 02.
Article
em En
| MEDLINE
| ID: mdl-34406402
ABSTRACT
Importance Surgical complications increase hospital costs by approximately $20â¯000 per admission and extend hospital stays by 9.7 days. Improving surgical care quality and reducing costs is needed for patients undergoing surgery, health care professionals, hospitals, and payers. Objective:
To evaluate the association of the Hospital-Acquired Conditions Present on Admission (HAC-POA) program, a mandated national pay-for-performance program by the Centers for Medicare & Medicaid Services, with surgical care quality and costs. Design, Setting, andParticipants:
A cross-sectional study of Medicare inpatient surgical care stays from October 2004 through September 2017 in the US was conducted. The National Inpatient Sample and a propensity score-weighted difference-in-differences analysis of hospital stays with associated primary surgical procedures was used to compare changes in outcomes for the intervention and control procedures before and after HAC-POA program implementation. The sample consisted of 1â¯317â¯262 inpatient surgical episodes representing 1â¯198â¯665 stays for targeted procedures and 118â¯597 stays for nontargeted procedures. Analyses were performed between November 1, 2020, and May 7, 2021. Exposures Implementation of the HAC-POA program for the intervention procedures included in this study (fiscal year 2009). Main Outcomes andMeasures:
Incidence of surgical site infections and deep vein thrombosis, length of stay, in-hospital mortality, and hospital costs. Analyses were adjusted for patient and hospital characteristics and indicators for procedure type, hospital, and year.Results:
In our propensity score-weighted sample, the intervention procedures group comprised 1â¯047â¯351 (88.5%) individuals who were White and 742â¯734 (60.6%) women; mean (SD) age was 75 (6.9) years. The control procedures group included 94â¯715 (88.0%) individuals who were White, and 65â¯436 (60.6%) women; mean (SD) age was 75 (7.1) years. After HAC-POA implementation, the incidence of surgical site infections in targeted procedures decreased by 0.3 percentage points (95% CI, -0.5 to -0.1 percentage points; P = .02) compared with nontargeted procedures. The program was associated with a reduction in length of stay by 0.5 days (95% CI, -0.6 to -0.4 days; P < .001) and hospital costs by 8.1% (95% CI, -10.2% to -6.1%; P < .001). No significant changes in deep vein thrombosis incidence and mortality were noted. Conclusions and Relevance The findings of this study suggest that the HAC-POA program is associated with small decreases in surgical site infection and length of stay and moderate decreases in hospital costs for patients enrolled in Medicare. Policy makers may consider these findings when evaluating the continuation and expansion of this program for other surgical procedures, and payers may want to consider adopting a similar policy.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
/
2_ODS3
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6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Reembolso de Incentivo
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Infecção da Ferida Cirúrgica
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Medicare
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Custos de Cuidados de Saúde
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Política de Saúde
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Hospitalização
Tipo de estudo:
Evaluation_studies
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Health_economic_evaluation
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Incidence_studies
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
/
Sysrev_observational_studies
Aspecto:
Implementation_research
Limite:
Aged
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Female
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Humans
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Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
JAMA Netw Open
Ano de publicação:
2021
Tipo de documento:
Article