Could Value-Based Purchasing Approach Be Used in Assessment of Healthcare Delivery Outputs?

Yıl 2019, Cilt: 11 Sayı: 3, 475 - 481, 23.10.2019

İsmail Simsir , Selma Altındiş

https://doi.org/10.18521/ktd.591897

Öz

ABSTRACT

In spite of increasing expenditures for health services, the lack of improvement in the quality and patient safety at the desired level brought about the search for reform of the reimbursement mechanisms. The main purpose of the present review is a search for a comprehensive answer for the question of “Can Value-based Purchasing (VPB) approach emerged as such kind of quest and applications developed in this context be used to evaluate the outputs of health service delivery?”. According to the studies, the VBP approach and especially Hospital Value-based Purchasing Program and Hospital-Acquired Conditions Program which are the two applications developed under this approach can provide effective results in evaluating the outputs in health services and improving quality and patient safety. The data show that the VBP approach in health care has the potential to contribute significantly to improving the quality and patient safety level of the health care service and to keep costs under control. In this context, Hospital Value-based Purchasing and Hospital-Acquired Conditions Programs draw attention in terms of its potential to be implemented especially in the public sphere in our country. The realization of the research and applications in our country aimed at revealing the potential benefits of the mentioned programs will facilitate the evaluation.

Anahtar Kelimeler

Value, Cost, Value-based Purchasing, Hospital Acquired Conditions

Sağlık Hizmet Sunumunun Çıktılarını Değerlendirmede Değer Bazlı Satın Alma Yaklaşımı Kullanılabilir mi?

Öz

ÖZET

Sağlık hizmetleri için yapılan harcamaların giderek artmasına rağmen, buna paralel olarak kalite ve hasta güvenliğinin istenen düzeyde gelişmemesi, geri ödeme mekanizmalarında reform arayışlarını beraberinde getirmiştir. Bu derlemenin temel amacı, “Bu tür arayışların sonucu olarak ortaya çıkan Değer Bazlı Satın Alma Yaklaşımı (DBSA) ve bu bağlamda geliştirilen uygulamalar, sağlık hizmet sunumunun çıktılarını (output) değerlendirmede kullanılabilir mi?” sorusuna kapsamlı bir cevap arayışıdır. Çalışmalara göre DBSA yaklaşımı ve bu yaklaşım kapsamında gelişen iki uygulama olan Hastane Değer Bazlı Satın Alma Programı ile Hastane Kaynaklı Durumlar Programı, sağlık hizmetlerinde sonuçların değerlendirilmesi ve kalite ve hasta güvenliğinin geliştirilmesinde etkili sonuçlar ortaya koyabilmektedir. Veriler, sağlık hizmetlerinde DBSA yaklaşımının, alınan sağlık hizmetinin kalite ve hasta güvenliği seviyesinin geliştirilerek maliyetlerin kontrol altında tutulmasına önemli düzeyde katkı sağlama potansiyeli barındırdığını göstermektedir. Bu kapsamdaki Hastane Değer Bazlı Satın Alma ve Hastane Kaynaklı Durumlar Programları ülkemizde, özellikle kamusal alanda uygulanabilme potansiyeli açısından dikkat çekmektedir. Söz konusu programların potansiyel faydalarını ortaya koymaya yönelik ülkemizde de araştırma ve uygulamaların gerçekleşmesi, değerlendirme açısından kolaylık sağlayacaktır.

Anahtar Kelimeler

Değer, Maliyet, Değer Bazlı Satın Alma, Hastane Kaynaklı Durumlar

Kaynakça

• Bennett CC. Are we there yet? A journey of health reform in Australia. Med J Aust. 2013;199(4):251–5.
• Blumenthal D, Dixon J. Health-care reforms in the USA and England: Areas for useful learning. Lancet [Internet]. 2012;380(9850):1352–7. Available from: http://dx.doi.org/10.1016/S0140-6736(12)60956-8
• Kohn LT, Corrigan JM, Donaldson MS. To Err is Human: Building a Safer Health System. National Academy Press. Washington, D.C.; 2000.
• Stanek M. Quality Measurement to Support Value-Based Purchasing : Aligning Federal and State Efforts [Internet]. Washington, DC: National Academy for State Health Policy; 2014. Available from: http://www.statecoverage.org/files/NASHP_Value-based_Purchasing.pdf
• Schuller K. Effectiveness of Medicare’s Nonpayment Policy on Hospital-Acquired Conditions. [dissertation]. University of South Carolina; 2012.
• Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;353(May):1–5.
• James J. Health Policy Brief: Pay-for-Performance. Health Aff. 2012;19:1–5.
• Rowland P. Power/Knowledge, Identity and Patient Safety: Intersections of Patient Safety and Professional Practice Discourses in a Canadian Acute Care Hospital. [Dissertation]. Fielding Graduate University; 2013.
• Gerhardt W, Korenda L, Morris DM, Vadnerkar G. The Road to Ralue-based Rare: Your Rileage may Vary [Internet]. Deloitte Center for Health Solutions; 2015. Available from: https://dupress.deloitte.com/content/dam/dup-us-en/articles/value-based-care-market-shift/DUP-1063_Value-based-care_vFINAL_5.11.15.pdf
• Maio V, Goldfarb NI, Carter C, Nash DB. Value-Based Purchasing: A Review of the Literature [Internet]. The Commonwealth Fund; 2003. Available from: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2003/may/value-based-purchasing--a-review-of-the-literature/maio_valuebased_636-pdf.pdf
• Deniz MH, Hobikoğlu EH. Türkiye ’ de “Değere Bağlı Sağlık Sistemi” Temelinde Kamu ve Özel Sektör Açısından Algılanan Hizmet Kalitesi. In: International Conference on Eurasian Economies. 2011. p. 160–6.
• Anderson GF, Frogner BK. Health Spending in OECD Countries: Obtaining Value Per Dollar. Health Aff. 2008;27(6):1718–27.
• Keckley P, Coughlin S, Gupta S. Value-based Purchasing : A Strategic Overview for Health Care Industry Stakeholders. Deloitte Cent Heal Solut. 2011;1–16.
• James MG, O’Kane ME, Salgo P, Weissberg J. Policy and Value-Based Purchasing. Am J Manag Care. 2013;19(9 Suppl):S168–73.
• The Payment Reform Glossary. Definitions and Explanations of the Terminology Used to Describe Methods of Paying for Healthcare Services [Internet]. Vol. First Edit. Center for Healthcare Quality and Payment Reform; [cited 2019 Mar 14]. Available from: http://www.chqpr.org/downloads/paymentreformglossary.pdf
• Harris D, Puskarz K. An Observational Study of Provider Perspectives on Alternative Payment Models. Popul Health Manag. 2017;20(5):402–10.
• Porter ME. What Is Value in Health Care? N Engl J Med. 2010 Dec 23;363(26):2477–81.
• Tracy B. Pay for Performance and Value-Based Care. In: Savarise M, Senkowski C, editors. Principles of Coding and Reimbursement for Surgeons. Switzerland: Springer International Publishing; 2017. p. 133–43.
• Glickman SW, Peterson ED. Best Practices and Innovative Healthcare Reform Models. Am J Manag Care. 2009;15(10):S300–5.
• Rosenthal MB. Beyond Pay for Performance - Emerging Models of Provider-Payment Reform. N Engl J Med. 2008;359(12):1197–200.
• Berenson RA. Moving Payment from Volume to Value : What Role for Performance Measurement ? [Internet]. Urban Institute. Washington, DC; 2010. Available from: https://folio.iupui.edu/bitstream/handle/10244/991/71568full.pdf
• Blumenthal D, Jena AB. Hospital Value-based Purchasing. J Hosp Med. 2013;8(5):271–7.
• VanLare JM, Conway H. Value-Based Purchasing — National Programs to Move from Volume to Value. Nejm. 2012;367(4):292–5.
• Meyer J, Rybowski L, Eichler R. Theory and Reality of Value-Based Purchasing: Lessons from the Pioneers. Agency for Health Care Policy and Research Department of Health and Human Services U.S.; 1997.
• Steinbrook R. The End of Fee-for-Service Medicine? Proposals for Payment Reform in Massachusetts. N Engl J Med. 2009;361(11):1036–8.
• Brantes FD, Rastogi A, Gosfeld A, Emery D, Machado E. Bundled and Fee-for-episode Payments: An Example. In: Young PL, Saunders RS, Olsen L, editors. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington D.C.: National Academies Press; 2010. p. 370–6.
• Young PL, Saunders RS, Olsen L. Payment and Payer-Based Strategies-Introduction. In: Young PL, Saunders RS, Olsen L, editors. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington D.C.; 2010. p. 359–61.
• Kavanagh KT, Cimiotti JP, Abusalem S, Coty MB. Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing. J Nurs Scholarsh. 2012;44(4):385–95.
• Medicare Hospital Value-Based Purchasing Plan Development Issues Paper 1 st Public Listening Session [Internet]. U.S. Department of Health and Human Services; 2007 [cited 2019 Mar 15]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/downloads/hospital_vbp_plan_issues_paper.pdf
• Brinkman SR. Value Based Purchasing in Healthcare and Dialogic Organization Development. [master’s thesis] The College of St. Scholastica, Duluth, MN; 2015.
• Hospital Value-Based Purchasing [Internet]. [cited 2019 Mar 7]. Available from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Hospital-Value-Based-Purchasing-.html
• Lee GM, Kleinman K, Soumerai SB, Tse A, Cole D, Fridkin SK, et al. Effect of Nonpayment for Preventable Infections in U.S. Hospitals. N Engl J Med. 2012;367(15):1428–37.
• LaBresh KA, Jarrett N, Lux L. Evidence-based Guidelines for Selected and Previously Considered Hospital- Acquired Conditions. RTI International; 2011.
• Rosenstein AH, O’Daniel M, White S, Taylor K. Medicare’s Value-Based Payment Initiatives: Impact on and Implications for Improving Physician Documentation and Coding. Am J Med Qual. 2009;24(3):250–8.
• Hospital-Acquired Conditions (Present on Admission Indicator) [Internet]. [cited 2019 Mar 7]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html
• Hospital-Acquired Conditions [Internet]. [cited 2019 Apr 30]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html
• Kavanagh KT. Financial incentives to promote health care quality: The hospital acquired conditions nonpayment policy. Soc Work Public Health. 2011;26(5):524–41.
• White KM, Brown J. “Present on Admission” Impacts Everyone’s practice. Nurs Manage. 2009;2–6.
• Şimşir İ. Geri Ödeme Mekanizmalarının Hasta Güvenliği Açısından Değerlendirilmesi (Bir Sistem Önerisi). [Yayımlanmamış Doktora Tezi]. Sakarya Üniversitesi; 2018.