Abstract:
OBJECTIVE:To demonstrate how expanding services covered by a "bundled payment" can also expand variation in the costs of treating patients under the bundle, using the Medicare dialysis program as an example. DATA SOURCES/STUDY SETTING:Observational claims-based study of 197,332 Medicare hemodialysis beneficiaries enrolled for at least one quarter during 2006-2008. STUDY DESIGN:We estimated how resource utilization (all health services, dialysis-related services, and medications) changes with intensity of secondary hyperparathyroidism (sHPT) treatment. DATA EXTRACTION METHODS:Using Medicare claims, a patient-quarter level dataset was constructed, including a measure of sHPT treatment intensity. PRINCIPAL FINDINGS:Under the existing, narrow dialysis bundle, utilization of covered services is relatively constant across treatment intensity groups; under a broader bundle, it rises more rapidly with treatment intensity. CONCLUSIONS:The broader Medicare dialysis bundle reimburses providers uniformly, even though patients treated more intensively for sHPT cost more to treat. Absent any payment adjustments or efforts to ensure quality, this flat payment schedule may encourage providers to avoid high-intensity patients or reduce their treatment intensity. The first incentive harms efficiency. The second may improve or worsen efficiency, depending on whether it reduces appropriate or inappropriate treatment.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Gupta C,Chertow GM,Linthicum MT,Van Nuys K,Belozeroff V,Quarles D,Lakdawalla DNdoi
10.1111/1475-6773.12202subject
Has Abstractpub_date
2014-12-01 00:00:00pages
1925-43issue
6eissn
0017-9124issn
1475-6773journal_volume
49pub_type
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更新日期:2010-12-01 00:00:00
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更新日期:2012-06-01 00:00:00
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更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:To assess the association between aggregate unemployment and hospital discharges for acute myocardial infarction (AMI) among adults and seniors, 1995-2011. DATA SOURCES/STUDY SETTING:Community hospital discharge data from states collected for the Healthcare Cost and Utilization Project (HCUP) State Inpatient...
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doi:10.1111/1475-6773.12298
更新日期:2015-10-01 00:00:00
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更新日期:2007-06-01 00:00:00
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更新日期:2017-10-01 00:00:00
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journal_title:Health services research
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更新日期:2000-02-01 00:00:00
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journal_title:Health services research
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更新日期:2006-08-01 00:00:00
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journal_title:Health services research
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doi:
更新日期:1994-12-01 00:00:00
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doi:
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doi:
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doi:
更新日期:1976-01-01 00:00:00
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更新日期:2017-08-01 00:00:00
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更新日期:1988-04-01 00:00:00
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2008-10-01 00:00:00
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更新日期:2003-08-01 00:00:00
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更新日期:1995-10-01 00:00:00
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pub_type: 杂志文章
doi:
更新日期:1993-08-01 00:00:00
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更新日期:2018-02-01 00:00:00
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更新日期:2011-06-01 00:00:00