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Alternate payment model

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https://www.readbyqxmd.com/read/28930760/medical-education-and-health-care-delivery-a-call-to-better-align-goals-and-purposes
#1
David P Sklar, Paul A Hemmer, Steven J Durning
The transformation of the U.S. health care system is under way, driven by the needs of an aging population, rising health care spending, and the availability of health information. However, the speed and effectiveness of the transformation of health care delivery will depend, in large part, upon engagement of the health professions community and changes in clinicians' practice behaviors. Current efforts to influence practice behaviors emphasize changes in the health payment system with incentives to move from fee-for-service to alternative payment models...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28885288/early-effects-of-medicare-s-bundled-payment-for-care-improvement-bpci-program-for-lumbar-fusion
#2
Brook I Martin, Jon D Lurie, Farrokh R Farrokhi, Kevin J McGuire, Sohail K Mirza
STUDY DESIGN: Retrospective analysis of Medicare claims linked to hospital participation in the Center for Medicare and Medicaid Innovation's episode-based Bundled Payment for Care Improvement (BPCI) program for lumbar fusion. OBJECTIVES: To describe the early effects of BPCI participation for lumbar fusion on 90-day reimbursement, procedure volume, reoperation, and readmission. SUMMARY OF BACKGROUND DATA: Initiated on January 1st, 2013, BPCI's voluntary bundle payment program provides a predetermined payment for services related to a Diagnosis Related Group-defined "triggering event" over a defined time period...
September 6, 2017: Spine
https://www.readbyqxmd.com/read/28885240/advancing-value-based-population-health-management-through-payer-provider-partnerships-improving-outcomes-for-children-with-complex-conditions
#3
Pamela Peele, Donna Keyser, John Lovelace, Deborah Moss
Population health management (PHM) approaches to improve cost and quality remain limited. To address this gap, stakeholders within an integrated delivery and financing system in Western Pennsylvania designed, implemented, and tested a value-based care model for children with medically complex conditions that could be scaled across the broader pediatric population. The model included: (1) a multilevel, interdisciplinary infrastructure; (2) actionable analytics reports to guide continuous quality improvement; (3) alternative provider payments; (4) consumer-directed spending accounts; and (5) shared savings with practices...
September 1, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28876455/the-age-friendly-health-system-imperative
#4
Terry Fulmer, Kedar S Mate, Amy Berman
The unprecedented changes happening in the American healthcare system have many on high alert as they try to anticipate legislative actions. Significant efforts to move from volume to value, along with changing incentives and alternative payment models, will affect practice and the health system budget. In tandem, growth in the population aged 65 and older is celebratory and daunting. The John A. Hartford Foundation is partnering with the Institute for Healthcare Improvement to envision an age-friendly health system of the future...
September 6, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28857975/finding-like-minded-partners-to-span-the-continuum-of-care
#5
Bruce Lawrence
This is an era of profound industry transformation, characterized by such forces as acceleration away from inpatient-centered care and toward alternative payment models, rising rates of chronic disease, and an aging population. Add to this mix physician and nurse shortages and a newfound understanding that today's patients are informed consumers, and the reality becomes clear: Healthcare providers must be adaptable, agile, and innovative to survive. Sometimes, the best way forward in transformative times is collaboration with other like-minded organizations...
October 2017: Frontiers of Health Services Management
https://www.readbyqxmd.com/read/28857887/reporting-from-the-front-lines-implementing-oregon-s-alternative-payment-methodology-in-federally-qualified-health-centers
#6
Erika K Cottrell, Jennifer D Hall, Glenn Kautz, Heather Angier, Sonja Likumahuwa-Ackman, Laura Sisulak, Sara Keller, David C Cameron, Jennifer E DeVoe, Deborah J Cohen
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment...
October 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/28845359/evaluation-design-recommendations-for-the-certified-community-behavioral-health-clinic-demonstration-program
#7
Joshua Breslau, J Scott Ashwood, Courtney Ann Kase, Harold Alan Pincus, Susan L Lovejoy
This article provides information and recommendations regarding the evaluation design of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Mandated by Congress in Section 223 of the Protecting Access to Medicare Act of 2014, the CCBHC is a new model of specialty behavioral health clinic, designed to provide comprehensive and integrated care for adults with mental health or substance-use disorders and children with serious emotional distress. Certification criteria for the CCBHCs have been specified by Substance Abuse and Mental Health Services Administration covering six core areas: staffing; accessibility; care coordination; scope of services; quality and other reporting; and organizational authority, governance, and accreditation...
June 2017: Rand Health Quarterly
https://www.readbyqxmd.com/read/28837458/early-lessons-on-bundled-payment-at-an-academic-medical-center
#8
Lindsay E Jubelt, Keith S Goldfeld, Saul B Blecker, Wei-Yi Chung, John A Bendo, Joseph A Bosco, Thomas J Errico, Anthony K Frempong-Boadu, Richard Iorio, James D Slover, Leora I Horwitz
INTRODUCTION: Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. METHODS: This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group)...
September 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28828573/a-cost-benefit-analysis-of-two-alternative-models-of-maternity-care-in-ireland
#9
Christopher G Fawsitt, Jane Bourke, Aileen Murphy, Brendan McElroy, Jennifer E Lutomski, Rosemary Murphy, Richard A Greene
BACKGROUND: The Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration. OBJECTIVES: To formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis. METHODS: A marginal payment scale willingness-to-pay question was adopted from an ex ante perspective...
August 21, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28754790/the-medicare-access-and-chip-reauthorization-act-implications-for-nephrology
#10
Eugene Lin, Thomas MaCurdy, Jay Bhattacharya
In response to rising Medicare costs, Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act in 2015. The law fundamentally changes the way that health care providers are reimbursed by implementing a pay for performance system that rewards providers for high-value health care. As of the beginning of 2017, providers will be evaluated on quality and in later years, cost as well. High-quality, cost-efficient providers will receive bonuses in reimbursement, and low-quality, expensive providers will be penalized financially...
September 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28748564/medicare-spending-for-breast-prostate-lung-and-colorectal-cancer-patients-in-the-year-of-diagnosis-and-year-of-death
#11
Christopher T Chen, Ling Li, Gabriel Brooks, Michael Hassett, Deborah Schrag
OBJECTIVE: To characterize spending patterns for Medicare patients with incident breast, prostate, lung, and colorectal cancer. DATA SOURCES/STUDY SETTING/STUDY DESIGN: 2007-2012 data from the Surveillance, Epidemiology, and End Results Program linked with Medicare fee-for-service claims. DATA COLLECTION/EXTRACTION METHODS: We calculate per-patient monthly and yearly mean and median expenditures, by cancer type, stage at diagnosis, and spending category, over the years of diagnosis and death...
July 26, 2017: Health Services Research
https://www.readbyqxmd.com/read/28722553/travelling-models-and-the-challenge-of-pragmatic-contexts-and-practical-norms-the-case-of-maternal-health
#12
REVIEW
Jean-Pierre Olivier de Sardan, Aïssa Diarra, Mahaman Moha
As in other areas of international development, we are witnessing the proliferation of 'traveling models' developed by international experts and introduced in an almost identical format across numerous countries to improve some aspect of maternal health systems in low- and middle-income countries. These policies and protocols are based on 'miracle mechanisms' that have been taken out of their original context but are believed to be intrinsically effective in light of their operational devices.In reality, standardised interventions are, in Africa and elsewhere, confronted with pragmatic implementation contexts that are always varied and specific, and which lead to drifts, distortions, dismemberments and bypasses...
July 12, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28717900/elements-of-program-design-in-medicare-s-value-based-and-alternative-payment-models-a-narrative-review
#13
Karen E Joynt Maddox, Aditi P Sen, Lok Wong Samson, Rachael B Zuckerman, Nancy DeLew, Arnold M Epstein
Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope (broad vs. narrow); selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both. We examined and classified current Medicare payment models-the Hospital Readmissions Reduction Program (HRRP), Hospital Value-Based Purchasing Program (HVBP), Hospital-Acquired Conditions Reduction Program (HACRP), Medicare Advantage Quality Star Rating program, Physician Value-Based Payment Modifier (VM) and its successor, the Merit-Based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP) on these elements of program design and reviewed the literature to place findings in context...
July 17, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28708195/build-your-own-payment-model
#14
Joey Berlin
Physicians participating in MACRA have a unique opportunity to create and submit their own alternative payment models to the government and take command of their own future payments. At least one Texas physician is taking a crack at developing his own model.
July 1, 2017: Texas Medicine
https://www.readbyqxmd.com/read/28696250/american-heart-association-s-call-to-action-for-payment-and-delivery-system-reform
#15
REVIEW
Vincent J Bufalino, Scott A Berkowitz, Timothy J Gardner, Ileana L Piña, Madeleine Konig
The healthcare system is undergoing a transition from paying for volume to paying for value. Clinicians, as well as public and private payers, are beginning to implement alternative delivery and payment models, such as the patient-centered medical home, accountable care organizations, and bundled payment arrangements. Implementation of these new models will necessitate delivery system transformation and will actively involve all fields of medical care, in particular medicine and surgery. This call to action, on behalf of the American Heart Association's Expert Panel on Payment and Delivery System Reform, serves to offer support and direction for further involvement by the American Heart Association...
August 15, 2017: Circulation
https://www.readbyqxmd.com/read/28685850/return-on-investment-roi-analyses-of-an-inpatient-lay-health-worker-model-on-30-day-readmission-rates-in-a-rural-community-hospital
#16
Roberto Cardarelli, Gregory Bausch, Joan Murdock, Michelle Renee Chyatte
PURPOSE: The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. METHODS: The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs)...
July 7, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/28676776/consumer-behavior-in-the-choice-of-mode-of-transport-a-case-study-in-the-toledo-madrid-corridor
#17
Ana I Muro-Rodríguez, Israel R Perez-Jiménez, Santiago Gutiérrez-Broncano
Within the context of the consumption of goods or services the decisions made by individuals involve the choice between a set of discrete alternatives, such as the choice of mode of transport. The methodology for analyzing the consumer behavior are the models of discrete choice based on the Theory of Random Utility. These models are based on the definition of preferences through a utility function that is maximized. These models also denominated of disaggregated demand derived from the decision of a set of individuals, who are formalized by the application of probabilistic models...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/28668203/principles-for-provider-incentives-in-cms-s-alternative-payment-models
#18
Julian Malinak, Matthew J Press, Rahul Rajkumar, Patrick H Conway
No abstract text is available yet for this article.
March 2017: Healthcare
https://www.readbyqxmd.com/read/28665678/why-oncologists-need-technology-to-succeed-in-alternative-payment-models
#19
Brenton Fargnoli, Ryan Holleran, Michael Kolodziej
No abstract text is available yet for this article.
April 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28665673/how-to-create-successful-alternative-payment-models-in-oncology
#20
Harold D Miller
No abstract text is available yet for this article.
April 2017: American Journal of Managed Care
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