Un rapport de la RAND Corporation, publi\u00e9 dans le cadre de sa s\u00e9rie de rapports de recherche en sant\u00e9, pr\u00e9sente des analyses portant sur la r\u00e9mun\u00e9ration des actes chirurgicaux par Medicare aux \u00c9tats-Unis, dans le cadre des \u00ab global surgical packages \u00bb. Ces forfaits int\u00e8grent la r\u00e9mun\u00e9ration de l\u2019acte op\u00e9ratoire lui-m\u00eame ainsi que les soins pr\u00e9- et postop\u00e9ratoires sur des p\u00e9riodes pr\u00e9d\u00e9finies (\u00ab global periods \u00bb). Les travaux portent sur la p\u00e9riode septembre 2023 \u2013 septembre 2025 et s\u2019inscrivent dans les r\u00e9flexions engag\u00e9es par les Centers for Medicare & Medicaid Services (CMS) pour am\u00e9liorer la valorisation de ces forfaits.<\/p>\n
Le rapport s\u2019appuie sur des donn\u00e9es de facturation afin de documenter les pratiques r\u00e9elles de soins postop\u00e9ratoires et de les comparer aux hypoth\u00e8ses sur lesquelles repose la tarification actuelle du Physician Fee Schedule (PFS). Quatre axes d\u2019analyse sont d\u00e9velopp\u00e9s : 1) la mesure, via des ratios observ\u00e9\/attendu (O\/E), du degr\u00e9 de r\u00e9alisation effective des consultations postop\u00e9ratoires incluses dans les forfaits chirurgicaux ; 2) l\u2019identification des types de services effectivement fournis pendant les p\u00e9riodes globales par des professionnels autres que le chirurgien principal ; 3) l\u2019examen de la sp\u00e9cialisation interne aux cabinets m\u00e9dicaux dans la prise en charge postop\u00e9ratoire lors des consultations d\u2019\u00e9valuation et de suivi (E&M) ; 4) l\u2019exploration de m\u00e9thodes alternatives de r\u00e9partition de la valorisation financi\u00e8re des forfaits chirurgicaux.<\/p>\n
Les CMS, autorit\u00e9 f\u00e9d\u00e9rale en charge de Medicare et Medicaid, ont r\u00e9affirm\u00e9 leur engagement \u00e0 am\u00e9liorer la pr\u00e9cision de la valorisation des services globaux, notamment dans la r\u00e8gle finale relative au Physician Fee Schedule 2026. Selon le rapport, l\u2019ampleur et la persistance des \u00e9carts entre, d\u2019une part, les sch\u00e9mas r\u00e9els de prise en charge des patients et, d\u2019autre part, les hypoth\u00e8ses sous-jacentes \u00e0 la tarification des actes chirurgicaux laissent pr\u00e9voir la n\u00e9cessit\u00e9 d\u2019une r\u00e9vision large de l\u2019ensemble des forfaits chirurgicaux globaux. Les analyses propos\u00e9es visent \u00e0 montrer comment une telle r\u00e9vision pourrait \u00eatre fond\u00e9e sur des donn\u00e9es empiriques, men\u00e9e de mani\u00e8re transparente et r\u00e9\u00e9valu\u00e9e r\u00e9guli\u00e8rement dans le temps.<\/p>\n
Le document souligne que toutes les publications de RAND font l\u2019objet d\u2019un examen par les pairs rigoureux afin de garantir la qualit\u00e9 scientifique et l\u2019objectivit\u00e9. RAND est une institution \u00e0 but non lucratif, et ses publications ne refl\u00e8tent pas n\u00e9cessairement les positions de ses financeurs publics ou priv\u00e9s. Le rapport est prot\u00e9g\u00e9 par le droit de la propri\u00e9t\u00e9 intellectuelle ; son utilisation est limit\u00e9e \u00e0 un usage non commercial, et toute r\u00e9utilisation \u00e0 des fins commerciales n\u00e9cessite une autorisation sp\u00e9cifique de RAND. Ces \u00e9l\u00e9ments peuvent pr\u00e9senter un int\u00e9r\u00eat pour le suivi comparatif des politiques de tarification des actes m\u00e9dicaux et des modalit\u00e9s de prise en compte des soins pr\u00e9- et postop\u00e9ratoires dans les syst\u00e8mes de r\u00e9mun\u00e9ration \u00e0 l\u2019acte.(contenu r\u00e9sum\u00e9 en fran\u00e7ais par l’IA)\u00a0Lire la Suite<\/a><\/p>","protected":false},"excerpt":{"rendered":" Un rapport de la RAND Corporation, publi\u00e9 dans le cadre de sa s\u00e9rie de rapports de recherche en sant\u00e9, pr\u00e9sente des analyses portant sur la r\u00e9mun\u00e9ration des actes chirurgicaux par 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