Qualitätsbezogene Vergütung für Krankenhäuser: Erste Erfahrungen aus den USA

Zusammenfassung

In den Vereinigten Staaten von Amerika ist seit 2004 die Veröffentlichung von Leistungsdaten für Krankenhäuser Voraussetzung für die Kostenerstattung durch die staatliche Krankenversicherung für 65-Jährige (Medicare) und Kostenerstattung für Krankenhäuser auf Leistungsbasis ist ab 2009 fest vorgesehen. Der Artikel erläutert das regulative Framework und diskutiert das erste größere Pilotprojekt für Kostenerstattung auf Leistungsbasis für Krankenhäuser, das CMS Premier Hospital Quality Incentive (HQI) Programm. Der Artikel widmet sich dann einer kritischen Diskussion des vorgeschlagenen Modells für Kostenerstattung auf Leistungsbasis für Krankenhäuser, das 2009 für landesweite Einführung vorgesehen ist.

Abstract

In the United States pay for reporting for hospitals has been well established since 2004 and the Center for Medicare & Medicaid Services (CMS) has committed to Pay for Performance by the fiscal year of 2009. The article outlines the regulatory environment including legislation passed by the US congress and explains the methodology and provides a critical discussion of the first major pay for performance pilot project for hospitals in the United States, the CMS Premier Hospital Quality Incentive (HQI) Demonstration. The article then focuses on CMS’ proposed methodology for the implementation of pay for performance for hospitals by 2009 and critically assesses challenges and opportunities.

Schlüsselwörter

Qualität - Vergütung für Krankenhäuser - Indikatoren

Key words

Quality of Case Reimbursement - Incentive Quality Indicators - Health Care

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3 Für klinische Gebiete mit Ergebnisindikatoren kann der Höchstwert etwas von 100 abweichen, da die Quotienten keinen absoluten Höchstwert besitzen.