The long-term effects of fee-for-service (FFS)-based reimbursement cuts on processes and outcomes of stroke care may be mixed, according to a new study by researchers at National Taiwan University (NTU). This study has been published online on December 9 in Circulation: Cardiovascular Quality and Outcomes, and also reported by Cardiovascular Business.
Conducted by Dr. Yu-Chi Tung, associate professor of health policy and management in the College of Public Health (CPH), NTU and her colleague, Professor Shou-Hsia Cheng, the study explored whether FFS-based reimbursement was helpful or detrimental to the nation’s health care system. It performed an interrupted time-series study using data from 411,487 stroke patients admitted to general acute care hospitals in Taiwan from 1997 to 2010. The long-term effects of FFS-based reimbursement cuts on trends in processes and outcomes of stroke care were examined.
After adjustments for secular trends and other confounding variables, the researchers found that the implementation of FFS-based reimbursement cuts was associated with increasing trend changes in computed tomography scanning/magnetic resonance imaging (0.31 percent per quarter; P = 0.013), physical therapy/occupational therapy assessment (0.25 percent per quarter; P < 0.001), and statin use (0.18 percent per quarter; P = 0.027). However, the cuts were also associated with negative effects on antiplatelet/anticoagulant use (−0.20 percent per quarter; P <0.001) and 30-day mortality (0.06 percent per quarter; P < 0.001).
“In other words, the FFS-based reimbursement cuts may ensure the provision of profitable services to patients, but the reimbursement cuts may place pressure on hospitals to reduce unprofitable services or levels of nurse staffing, which are in turn associated with mortality,” the authors write. “It is imperative that we reduce costs and improve value, but at the same time we need to pay more attention to identifying unexpected effects that are associated with slow improvements in outcomes of stroke care.”