An evidence - based incentive system for medicare's end - stage renal disease program / Donald K. K. Lee in Management science, Vol. 58 N° 6 (Juin 2012)  

Public ISBD [article]  inManagement science > Vol. 58 N° 6 (Juin 2012) . - pp. 1092-1105 Titre : An evidence - based incentive system for medicare's end - stage renal disease program Type de document : texte imprimé Auteurs : Donald K. K. Lee, Auteur ; Stefanos A. Zenios, Auteur Année de publication : 2012 Article en page(s) : pp. 1092-1105 Note générale : Management Langues : Anglais (eng) Mots-clés : Healthcare pay-for-performance Dialysis Evidence-based mechanism design Structural estimation Résumé : Recent legislations directed Medicare to revamp its decades-old system for reimbursing dialysis treatments, with focus on the risk adjustment of payments and on the transition toward a pay-for-compliance system. To design an optimal payment system that incorporates these features, we develop an empirical method to estimate the structural parameters of the principal–agent model underlying Medicare's dialysis payment system. We use the model and parameter estimates to answer the following questions: Can a pay-for-compliance system based only on the intermediate performance measures currently identified by Medicare achieve first-best? How should patient outcomes be risk adjusted, and what welfare gains can be achieved by doing so? Our main findings are as follows: (1) the current set of intermediate measures identified by Medicare are not comprehensive enough for use alone in a pay-for-compliance system; (2) paying for risk-adjusted downstream outcomes instead of raw downstream outcomes can lengthen the hospital-free life of admitted patients by two weeks per patient per year without increasing Medicare expenditures. ISSN : 0025-1909 En ligne : http://mansci.journal.informs.org/content/58/6/1092.short [article] An evidence - based incentive system for medicare's end - stage renal disease program [texte imprimé] / Donald K. K. Lee, Auteur ; Stefanos A. Zenios, Auteur . - 2012 . - pp. 1092-1105. Management Langues : Anglais (eng) in Management science > Vol. 58 N° 6 (Juin 2012) . - pp. 1092-1105 Mots-clés : Healthcare pay-for-performance Dialysis Evidence-based mechanism design Structural estimation Résumé : Recent legislations directed Medicare to revamp its decades-old system for reimbursing dialysis treatments, with focus on the risk adjustment of payments and on the transition toward a pay-for-compliance system. To design an optimal payment system that incorporates these features, we develop an empirical method to estimate the structural parameters of the principal–agent model underlying Medicare's dialysis payment system. We use the model and parameter estimates to answer the following questions: Can a pay-for-compliance system based only on the intermediate performance measures currently identified by Medicare achieve first-best? How should patient outcomes be risk adjusted, and what welfare gains can be achieved by doing so? Our main findings are as follows: (1) the current set of intermediate measures identified by Medicare are not comprehensive enough for use alone in a pay-for-compliance system; (2) paying for risk-adjusted downstream outcomes instead of raw downstream outcomes can lengthen the hospital-free life of admitted patients by two weeks per patient per year without increasing Medicare expenditures. ISSN : 0025-1909 En ligne : http://mansci.journal.informs.org/content/58/6/1092.short

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