Medicare uses a pay-for-performance program to reimburse hospitals. One of the key input measures in the performance formula is patient satisfaction with their hospital care. Physicians and hospitals, however, have raised concerns especially about questions related to patient satisfaction with pain management during hospitalization. They report feeling pressured to prescribe opioids to alleviate pain and boost satisfaction survey scores for higher reimbursements. This over-prescription of opioids has been cited as a cause of current opioid crisis in the US. Due to these concerns, Medicare stopped using pain management questions as inputs in its payment formula. We collected multi-year data from six diverse data sources, employed propensity score matching to obtain comparable groups, and estimated difference-in-difference models to show that, in fact, pain management was the only measure to improve in response to pay-for-performance system. No other input measure showed significant improvement. Thus, removing pain management from the formula may weaken the effectiveness of HVBP program at improving patient satisfaction, which is one of the key goals of the program. We suggest two divergent paths for Medicare to make the program more effective.

Medicare使用按绩效付费计划来偿还医院费用。绩效公式中的关键输入指标之一是患者对其医院护理的满意度。但是，内科医生和医院尤其对与患者对住院期间疼痛治疗的满意度有关的问题提出了担忧。他们报告说，在开处方阿片类药物以减轻疼痛和提高满意度调查分数以获得更高的报销方面感到压力很大。阿片类药物的这种过量处方被认为是导致美国目前阿片类药物危机的原因。由于这些担忧，Medicare停止使用疼痛管理问题作为其付款公式中的输入。我们从六个不同的数据源中收集了多年的数据，使用倾向得分匹配来获得可比较的组，并估算了差异差异模型以表明，实际上，疼痛管理是针对按绩效付费系统做出改进的唯一措施。没有其他投入措施显示出显着改善。因此，从配方中去除疼痛管理可能会削弱HVBP计划在提高患者满意度方面的有效性，这是该计划的关键目标之一。我们建议医疗保险采取两条不同的途径来使该计划更加有效。