Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis

BMC Health Services Research

Deanna P. Jannat-Khah¹  Salomeh Keyhani²  Said Ibrahim³  Sri Lekha Tummalapalli⁴  Michelle M. Estrella⁵ 

[1] Department of Medicine, Weill Cornell Medicine, New York, NY, USA;Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA;Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA;Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, 402 East 67th Street, 10065, New York, NY, USA;Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, 402 East 67th Street, 10065, New York, NY, USA;Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA;Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA, USA;Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA, USA;Division of Nephrology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA;

关键词: Capitation;    Fee-for-service;    Physician reimbursement;    Health services research;    Chronic disease;    Hypertension;    Diabetes;    Chronic kidney disease;   

DOI  :  10.1186/s12913-021-07313-3

来源: Springer

【 摘 要 】

BackgroundUpcoming alternative payment models Primary Care First (PCF) and Kidney Care Choices (KCC) incorporate capitated payments for chronic disease management. Prior research on the effect of capitated payments on chronic disease management has shown mixed results. We assessed the patient, physician, and practice characteristics of practices with capitation as the majority of revenue, and evaluated the association of capitated reimbursement with quality of chronic disease care.MethodsWe performed a cross-sectional analysis of visits in the United States’ National Ambulatory Medical Care Survey (NAMCS) for patients with hypertension, diabetes, or chronic kidney disease (CKD). Our predictor was practice reimbursement type, classified as 1) majority capitation, 2) majority FFS, or 3) other reimbursement mix. Outcomes were quality indicators of hypertension control, diabetes control, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use, and statin use.ResultsAbout 9% of visits were to practices with majority capitation revenue. Capitated practices, compared with FFS and other practices, had lower visit frequency (3.7 vs. 5.2 vs. 5.2, p = 0.006), were more likely to be located in the West Census Region (55% vs. 18% vs. 17%, p < 0.001), less likely to be solo practice (21% vs. 37% vs. 35%, p = 0.005), more likely to be owned by an insurance company, health plan or HMO (24% vs. 13% vs. 13%, p = 0.033), and more likely to have private insurance (43% vs. 25% vs. 19%, p = 0.004) and managed care payments (69% vs. 23% vs. 26%, p < 0.001) as the majority of revenue. The prevalence of controlled hypertension, controlled diabetes, ACEi/ARB use, and statin use was suboptimal across practice reimbursement types. Capitated reimbursement was not associated with differences in hypertension, diabetes, or CKD quality indicators, in multivariable models adjusting for patient, physician, and practice characteristics.ConclusionsPractices with majority capitation revenue differed substantially from FFS and other practices in patient, physician, and practice characteristics, but were not associated with consistent quality differences. Our findings establish baseline estimates of chronic disease quality of care performance by practice reimbursement composition, informing chronic disease care delivery within upcoming payment models.

【 授权许可】

CC BY