隶属于卫生系统的临床医生在基于绩效的激励支付系统中表现更好—小柯机器人—科学网

隶属于卫生系统的临床医生在基于绩效的激励支付系统中表现更好 作者： 发布时间：2020/9/12 21:43:00 美国华盛顿大学圣路易斯分校Karen E. Joynt Maddox联合圣路易斯大学Kenton J. Johnston团队，研究了基于绩效的医疗保险激励支付系统中临床医生的绩效与是否隶属于卫生系统的相关性。2020年9月8日，《美国医学会杂志》发表了该成果。

在以价值为基础的支付时代，将医生实践纳入由医院和多专科实践组成的卫生系统的做法越来越多。尚不清楚隶属于此类卫生系统的临床医生在新的强制性医疗保险和医疗补助服务中基于绩效的激励支付系统（MIPS）方面相对于其他同行的表现如何。

研究组采用全美636552名在门诊、诊所工作的临床医生的公开报告数据，来评估609个卫生系统中临床医生的隶属状况与其2019年最终MIPS绩效评分与基于价值的报销之间的关联，并根据临床医生、患者和执业领域特征进行校正。主要结果是最终的MIPS绩效评分(0-100；分数越高，表现越好)。次要结果是MIPS支付调整，包括负（罚款）支付调整、正支付调整和奖金支付调整。

636552名临床医生中41%为女性，83%为医生，50%为初级保健者，17%在农村地区，48.6%的人隶属于卫生系统。与非隶属卫生系统的临床医师相比，隶属于卫生系统的临床医师中女性（46%和37%）、初级保健者（36%和30%）和安全网络临床医师（12%和10%）的比例显著升高，专科医师比例则显著降低（44%和55%）。

隶属于卫生系统的临床医生最终MIPS绩效得分均值为79.0分，非隶属于卫生系统的临床医生为60.3分。隶属于卫生系统的临床医生和非隶属临床医生相比，接受负支付调整（罚款）的比例分别为2.8%和13.7%，接受正支付调整的比例分别为97.1%和82.6%，接受奖金支付调整的比例分别为73.9%和55.1%。

总之，隶属于卫生系统的临床医生2019年MIPS绩效得分显著高于非隶属临床医生。

附：英文原文

Title: Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System

Author: Kenton J. Johnston, Timothy L. Wiemken, Jason M. Hockenberry, Jose F. Figueroa, Karen E. Joynt Maddox

Issue Volume: 2020/09/08

Abstract:

Importance Integration of physician practices into health systems composed of hospitals and multispecialty practices is increasing in the era of value-based payment. It is unknown how clinicians who affiliate with such health systems perform under the new mandatory Centers for Medicare Medicaid Services Merit-based Incentive Payment System (MIPS) relative to their peers.

Objective To assess the relationship between the health system affiliations of clinicians and their performance scores and value-based reimbursement under the 2019 MIPS.

Design, Setting, and Participants Publicly reported data on 636552 clinicians working at outpatient clinics across the US were used to assess the association of the affiliation status of clinicians within the 609 health systems with their 2019 final MIPS performance score and value-based reimbursement (both based on clinician performance in 2017), adjusting for clinician, patient, and practice area characteristics.

Exposures Health system affiliation vs no affiliation.

Main Outcomes and Measures The primary outcome was final MIPS performance score (range, 0-100; higher scores intended to represent better performance). The secondary outcome was MIPS payment adjustment, including negative (penalty) payment adjustment, positive payment adjustment, and bonus payment adjustment.

Results The final sample included 636552 clinicians (41% female, 83% physicians, 50% in primary care, 17% in rural areas), including 48.6% who were affiliated with a health system. Compared with unaffiliated clinicians, system-affiliated clinicians were significantly more likely to be female (46% vs 37%), primary care physicians (36% vs 30%), and classified as safety net clinicians (12% vs 10%) and significantly less likely to be specialists (44% vs 55%) (P .001 for each). The mean final MIPS performance score for system-affiliated clinicians was 79.0 vs 60.3 for unaffiliated clinicians (absolute mean difference, 18.7 [95% CI, 18.5 to 18.8]). The percentage receiving a negative (penalty) payment adjustment was 2.8% for system-affiliated clinicians vs 13.7% for unaffiliated clinicians (absolute difference, 10.9% [95% CI, 11.0% to 10.7%]), 97.1% vs 82.6%, respectively, for those receiving a positive payment adjustment (absolute difference, 14.5% [95% CI, 14.3% to 14.6%]), and 73.9% vs 55.1% for those receiving a bonus payment adjustment (absolute difference, 18.9% [95% CI, 18.6% to 19.1%]).

Conclusions and Relevance Clinician affiliation with a health system was associated with significantly better 2019 MIPS performance scores. Whether this represents differences in quality of care or other factors requires additional research.

DOI: 10.1001/jama.2020.13136

Source:

期刊信息

JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：51.273

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