A pain relieving reimbursement program? Effects of a value-based reimbursement program on patient reported outcome measures

BMC Health Services Research - Tập 20 - Trang 1-11 - 2020
Thérèse Eriksson1, Hans Tropp2, Ann-Britt Wiréhn3, Lars-Åke Levin1
1Department of Health, Medicine and Caring Sciences (HMV), Centre for Medical Technology Assessment (CMT), Linköping University, Linköping, Sweden
2Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden
3Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden

Tóm tắt

Value-based reimbursement programs have become increasingly common. However, little is known about the effect of such programs on patient reported outcomes. Thus, the aim of this study was to analyze the effect of introducing a value-based reimbursement program on patient reported outcome measures and to explore whether a selection bias towards less complicated patients occurred. This is a retrospective observational study with a before and after design based on the introduction of a value-based reimbursement program in Region Stockholm, Sweden. We analyzed patient level data from inpatient and outpatient care of patients undergoing lumbar spine surgery during 2006–2015. Patient reported outcome measures used was Global Assessment, EQ-5D-3L and Oswestry Disability Index. The case-mix of surgically treated patients was analyzed using medical and socioeconomic factors. The value-based reimbursement program did not have any effect on targeted or non-targeted patient reported outcome measures. Moreover, the share of surgically treated patients with risk factors such as having comorbidities and being born outside of Europe increased after the introduction. Hence, the value-based reimbursement program did not encourage discrimination against sicker patients. However, the income was higher among patients surgically treated after the introduction of the value-based reimbursement. This indicates that a value-based reimbursement program may contribute to increased inequalities in access to healthcare. The value-based reimbursement program did not have any effect on patient reported outcome measures. Our study contributes to the understanding of the effects of a value-based reimbursement program on patient reported outcome measures and to what extent cherry-picking arises.

Tài liệu tham khảo

Dranove D, White WD. Agency and the organization of health care delivery. Inquiry. 1987;24(4):405–15. Conrad DA. The theory of value-based payment incentives and their application to health care. Health Serv Res. 2015;50(Suppl 2):2057–89. Lemak CH, Nahra TA, Cohen GR, Erb ND, Paustian ML, Share D, Hirth RA. Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care. Health Aff (Project Hope). 2015;34(4):645–52. Busse R, Geissler A, Aaviksoo A, Cots F, Hakkinen U, Kobel C, Mateus C, Or Z, O'Reilly J, Serden L, et al. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? BMJ (Clinical research ed). 2013;346:f3197. Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477–81. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet (London, England). 2018;391(10137):2368–83. Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T, Buchbinder R. Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol. 2010;24(2):155–65. Olafsson G, Jonsson E, Fritzell P, Hagg O, Borgstrom F. A health economic lifetime treatment pathway model for low back pain in Sweden. J Med Econ. 2017;20(12):1281–9. Ryan AM. Medicare bundled payment programs for joint replacement: anatomy of a successful payment reform. JAMA. 2018;320(9):877–8l79. Ugiliweneza B, Kong M, Nosova K, Huang KT, Babu R, Lad SP, Boakye M. Spinal surgery: variations in health care costs and implications for episode-based bundled payments. Spine. 2014;39(15):1235–42. Damberg CL, Sorbero ME, Lovejoy SL, Martsolf GR, Raaen L, Mandel D. Measuring success in health care value-based purchasing programs: findings from an environmental scan, literature review, and expert panel discussions. Rand Health Q. 2014;4(3):9. Scott A, Liu M, Yong J. Financial incentives to encourage value-based health care. Med Care Res Rev. 2018;75(1):3–32. Eijkenaar F, Emmert M, Scheppach M, Schoffski O. Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy (Amsterdam, Netherlands). 2013;110(2–3):115–30. Kondo KK, Damberg CL, Mendelson A, Motu'apuaka M, Freeman M, O'Neil M, Relevo R, Low A, Kansagara D. Implementation processes and pay for performance in healthcare: a systematic review. J Gen Intern Med. 2016;31(Suppl 1):61–9. Christianson JB, Leatherman S, Sutherland K. Lessons from evaluations of purchaser pay-for-performance programs: a review of the evidence. Med Care Res Rev. 2008;65(6 Suppl):5s–35s. Shih T, Chen LM, Nallamothu BK. Will bundled payments change health care? Examining the evidence thus far in cardiovascular care. Circulation. 2015;131(24):2151–8. Feldhaus I, Mathauer I. Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature. BMC Health Serv Res. 2018;18(1):996. Donabedian A: Evaluating the quality of medical care. Milbank Mem Fund Q 1966, 44(3):Suppl:166–206. Porter ME. Value-based health care delivery. Ann Surg. 2008;248(4):503–9. Halawi MJ, Cote MP, Savoy L, Williams VJ, Lieberman JR. The effect of payer type on patient-reported outcomes in Total joint Arthroplasty is modulated by baseline patient characteristics. J Arthroplast. 2019;34(6):1072–5. Finkelstein A, Ji Y, Mahoney N, Skinner J. Mandatory medicare bundled payment program for lower extremity joint replacement and discharge to institutional postacute care: interim analysis of the first year of a 5-year randomized trial. JAMA. 2018;320(9):892–900. Roland M, Campbell S. Successes and failures of pay for performance in the United Kingdom. N Engl J Med. 2014;370(20):1944–9. Stromqvist B, Fritzell P, Hagg O, Jonsson B, Sanden B. Swespine: the Swedish spine register : the 2012 report. Eur Spine J. 2013;22(4):953–74. Parai C, Hagg O, Lind B, Brisby H. The value of patient global assessment in lumbar spine surgery: an evaluation based on more than 90,000 patients. Eur Spine J. 2017;27(3):554–63. Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997;35(11):1095–108. EuroQol Research Foundation: EQ-5D-3L User Guide; 2018. https://euroqol.org/publications/user-guides. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000;25(22):2940–52 discussion 2952. Hills JM, Weisenthal B, Sivaganesan A, Bydon M, Archer KR, Devin CJ. Value based spine care: paying for outcomes, not volume. Sem Spine Surg. 2019;31(1):12–9. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299–309. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57(12):1288–94. Forsth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, Ohagen P, Michaelsson K, Sanden B. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):1413–23. Skold C, Tropp H, Berg S. Five-year follow-up of total disc replacement compared to fusion: a randomized controlled trial. Eur Spine J. 2013;22(10):2288–95. Iderberg H, Willers C, Borgstrom F, Hedlund R, Hagg O, Moller H, Ornstein E, Sanden B, Stalberg H, Torevall-Larsson H, et al. Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden: a multi-register evaluation. Eur Spine J. 2019;28(6):1423–32. Steel N, Willems S. Research learning from the UK quality and outcomes framework: a review of existing research. Qual Prim Care. 2010;18(2):117–25. Mullen KJ, Frank RG, Rosenthal MB. Can you get what you pay for? Pay-for-performance and the quality of healthcare providers. RAND J Econ. 2010;41(1):64–91. Dudley RA, Frolich A, Robinowitz DL, Talavera JA, Broadhead P, Luft HS. AHRQ Technical Reviews. In: Strategies To Support Quality-based Purchasing: A Review of the Evidence. Rockville: Agency for Healthcare Research and Quality (US); 2004. Kalakoti P, Gao Y, Hendrickson NR, Pugely AJ. Preparing for bundled payments in cervical spine surgery: do we understand the influence of patient, hospital, and procedural factors on the cost and length of stay? Spine. 2019;44(5):334–45. Dietz N, Sharma M, Alhourani A, Ugiliweneza B, Wang D, Nuno MA, Drazin D, Boakye M. Bundled payment models in spine surgery: current challenges and opportunities, a systematic review. World Neurosurg. 2019;123:177–83. Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American pain society clinical practice guideline. Spine. 2009;34(10):1094–109. Sullivan R, Jarvis LD, O'Gara T, Langfitt M, Emory C. Bundled payments in total joint arthroplasty and spine surgery. Curr Rev Musculoskelet Med. 2017;10(2):218–23. Kazberouk A, McGuire K, Landon BE. A survey of innovative reimbursement models in spine care. Spine. 2016;41(4):344–52. Song Z, Safran DG, Landon BE, Landrum MB, He Y, Mechanic RE, Day MP, Chernew ME. The 'Alternative Quality Contract,' based on a global budget, lowered medical spending and improved quality. Health Affairs (Project Hope). 2012;31(8):1885–94. Walshe K. Pseudoinnovation: the development and spread of healthcare quality improvement methodologies. Int J Qual Health Care. 2009;21(3):153–9. Fredriksson JJ, Ebbevi D, Savage C. Pseudo-understanding: an analysis of the dilution of value in healthcare. BMJ Qual Saf. 2015;24(7):451–7.