■Medicare的基于医院价值的购买(HVBP)计划将为具有更大比例的双重符合Medicare和Medicaid资格的患者的医院提供健康公平调整(HEA)从2026财政年度开始提供高质量的护理。然而,哪些医院将从这一政策变化中受益最大,以及在多大程度上是未知的。
■为了评估HEA后医院绩效的潜在变化,并检查医院患者组合,结构,以及与收到增加的付款相关的地理特征。
■这项横断面研究分析了2021财年参与HVBP计划的所有2676家医院。有关计划绩效和医院特征的公开数据已与每家医院双重资格受益人的所有住院医疗保险索赔数据相关联,以计算HEA积分和HVBP付款调整。
■医院基于价值的采购计划HEA。
■HVBP奖金或罚款状态的重新分类以及跨医院特征的付款调整的变化。
■在2021财年参与HVBP计划的2676家医院中,有1470家(54.9%)获得奖金,有1206家(45.1%)获得罚款。在HEA之后,102家医院(6.9%)从奖金状态重新分类为惩罚状态,而119名(9.9%)被从惩罚状态重新分类为奖励状态。在医院层面,HEA后,平均(SD)HVBP付款调整减少4534美元(9033美元),从最高减少1014276美元到最高增加1523765美元不等。在聚合级别,在安全网医院(28971708美元)和照顾黑人患者比例较高的医院(15468445美元)中,付款调整的净积极变化最大。与非安全网医院相比,安全网中的付款调整增加的可能性明显更高(683家医院中的574家[84.0%]对1993年的709家[35.6%];调整后的比率[ARR],2.04[95%CI,1.89-2.20])和高比例黑人医院与非高比例黑人医院(523家医院中的396家[75.7%]对2153家医院中的887家[41.2%];ARR,1.40[95%CI,1.29-1.51])。农村医院(612家医院中的374家[61.1%]对2064年的909家[44.0%];ARR,1.44[95%CI,1.30-1.58]),以及位于南部的那些(1040中的598[57.5%]对439中的192[43.7%];ARR,1.25[95%CI,1.10-1.42])和医疗补助扩展状态(1651中的801[48.5%]对1025中的482[47.0%];ARR,1.16[95%CI,1.06-1.28]),与他们的城市相比,HEA后更有可能经历更多的支付调整,东北,和医疗补助非扩张州同行,分别。
■Medicare在HVBP计划中实施HEA将大大重新分类医院绩效并重新分配计划付款,安全网和高比例的黑人医院从这一政策变化中受益最大。这些发现表明,HEA是确保基于价值的支付计划更加公平的重要策略。
Medicare\'s Hospital Value-Based Purchasing (HVBP) program will provide a health equity adjustment (HEA) to hospitals that have greater proportions of patients dually eligible for Medicare and Medicaid and that offer high-quality care beginning in fiscal year 2026. However, which hospitals will benefit most from this policy change and to what extent are unknown.
To estimate potential changes in hospital performance after HEA and examine hospital patient mix, structural, and geographic characteristics associated with receipt of increased payments.
This cross-sectional study analyzed all 2676 hospitals participating in the HVBP program in fiscal year 2021. Publicly available data on program performance and hospital characteristics were linked to Medicare claims data on all inpatient stays for dual-eligible beneficiaries at each hospital to calculate HEA points and HVBP payment adjustments.
Hospital Value-Based Purchasing program HEA.
Reclassification of HVBP bonus or penalty status and changes in payment adjustments across hospital characteristics.
Of 2676 hospitals participating in the HVBP program in fiscal year 2021, 1470 (54.9%) received bonuses and 1206 (45.1%) received penalties. After HEA, 102 hospitals (6.9%) were reclassified from bonus to penalty status, whereas 119 (9.9%) were reclassified from penalty to bonus status. At the hospital level, mean (SD) HVBP payment adjustments decreased by $4534 ($90 033) after HEA, ranging from a maximum reduction of $1 014 276 to a maximum increase of $1 523 765. At the aggregate level, net-positive changes in payment adjustments were largest among safety net hospitals ($28 971 708) and those caring for a higher proportion of Black patients ($15 468 445). The likelihood of experiencing increases in payment adjustments was significantly higher among safety net compared with non-safety net hospitals (574 of 683 [84.0%] vs 709 of 1993 [35.6%]; adjusted rate ratio [ARR], 2.04 [95% CI, 1.89-2.20]) and high-proportion Black hospitals compared with non-high-proportion Black hospitals (396 of 523 [75.7%] vs 887 of 2153 [41.2%]; ARR, 1.40 [95% CI, 1.29-1.51]). Rural hospitals (374 of 612 [61.1%] vs 909 of 2064 [44.0%]; ARR, 1.44 [95% CI, 1.30-1.58]), as well as those located in the South (598 of 1040 [57.5%] vs 192 of 439 [43.7%]; ARR, 1.25 [95% CI, 1.10-1.42]) and in Medicaid expansion states (801 of 1651 [48.5%] vs 482 of 1025 [47.0%]; ARR, 1.16 [95% CI, 1.06-1.28]), were also more likely to experience increased payment adjustments after HEA compared with their urban, Northeastern, and Medicaid nonexpansion state counterparts, respectively.
Medicare\'s implementation of HEA in the HVBP program will significantly reclassify hospital performance and redistribute program payments, with safety net and high-proportion Black hospitals benefiting most from this policy change. These findings suggest that HEA is an important strategy to ensure that value-based payment programs are more equitable.