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outcomes based payment

Lisa B VanWagner, Fasiha Kanwal
With the passage of the Affordable Care Act (ACA) followed by the physician payment reform, there is an urgent need to better understand the complex relationships between structure (including incentives), processes, and outcomes of health care and, based on this understanding, identify interventions that can ensure delivery of high value care to patients with liver disease. As hepatologists, how do we systematically address these issues and ensure that we provide high-value care to our patients? These factors combine in the burgeoning field of health services research...
March 14, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Rishi K Wadhera, Karen E Joynt Maddox, Yun Wang, Changyu Shen, Deepak L Bhatt, Robert W Yeh
BACKGROUND: Recent policy efforts have focused on improving the value of acute myocardial infarction (AMI) care. Medicare payment programs, for example, increasingly evaluate hospital performance based on spending, as determined by payments made to institutions and providers, and outcome measures for a longitudinal episode of AMI care. Little is known about the relationship between total 30-day payments-both in the inpatient and immediate postdischarge timeframe-and outcomes after an admission for AMI...
March 2018: Circulation. Cardiovascular Quality and Outcomes
Laurent G Glance, Richard P Dutton, Changyong Feng, Yue Li, Stewart J Lustik, Andrew W Dick
BACKGROUND: Under the Merit-based Incentive Payment System, physician payment will be adjusted using a composite performance score that has 4 components, one of which is resource use. The objective of this exploratory study is to quantify the facility-level variation in surgical case duration for common surgeries to examine the feasibility of using surgical case duration as a performance metric. METHODS: We used data from the National Anesthesia Clinical Outcomes Registry on 404,987 adult patients undergoing one of 6 general surgical or orthopedic procedures: laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic cholecystectomy with intraoperative cholangiogram, knee arthroscopy, laminectomy, and total hip replacement...
March 6, 2018: Anesthesia and Analgesia
Ashish Atreja, Emamuzo Otobo, Karthik Ramireddy, Allyssa Deorocki
PURPOSE OF REVIEW: Mobile apps are now increasingly used in conjunction with telemedicine and wearable devices to support remote patient monitoring (RPM). The goal of this paper is to review the available evidence and assess the scope of RPM integration into standard practices for care and management of chronic disease in general and, more specifically, inflammatory bowel disease (IBD). RECENT FINDINGS: RPM has been associated with improvements in health outcomes and indicators across a broad range of chronic diseases...
March 7, 2018: Current Gastroenterology Reports
Derek Charles, Sylvester Boyd, Logan Heckert, Austin Lake, Kevin Petersen
Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes...
2018: Journal of Allied Health
Carolyn S Langer, Richard C Antonelli, Lisa Chamberlain, Richard J Pan, David Keller
Irrespective of any future changes in federal health policy, the momentum to shift from fee-for-service to value-based payment systems is likely to persist. Public and private payers continue to move toward alternative payment models that promote novel care-delivery systems and greater accountability for health outcomes. With a focus on population health, patient-centered medical homes, and care coordination, alternative payment models hold the potential to promote care-delivery systems that address the unique needs of children with medical complexity (CMC), including nonmedical needs and the social determinants of health...
March 2018: Pediatrics
Jennifer C Samp, Min J Joo, Glen T Schumock, Gregory S Calip, A Simon Pickard, Todd A Lee
BACKGROUND: With increasing health care costs that have outpaced those of other industries, payers of health care are moving from a fee-for-service payment model to one in which reimbursement is tied to outcomes. Chronic obstructive pulmonary disease (COPD) is a disease where this payment model has been implemented by some payers, and COPD exacerbations are a quality metric that is used. Under an outcomes-based payment model, it is important for health systems to be able to identify patients at risk for poor outcomes so that they can target interventions to improve outcomes...
March 2018: Journal of Managed Care & Specialty Pharmacy
Burton L Edelstein
Health care costs have traditionally been provider generated whereas payment has been split between public and private sources. There has been little pressure on health care providers to demonstrate value. The quest for value in health care financing is now widely evident as demonstrated by governmental and private sector pursuits of a 3-part aim: better health outcomes at lower cost with improved patient and population experience. Value-based approaches involve payment innovation with its attendant constraints and opportunities for innovation...
April 2018: Dental Clinics of North America
Laura C Seeff, Tricia McGinnis, Hilary Heishman
CONTEXT: As the US health care system continues to undergo dynamic change, the increased alignment between health care quality and payment has provided new opportunities for public health and health care sectors to work together. PROGRAM: The Centers for Disease Control and Prevention's 6|18 Initiative accelerates cross-sector collaboration between public health and health care purchasers, payers, and providers and highlights 6 high-burden conditions and 18 associated interventions with evidence of cost reduction/neutrality and improved health outcomes...
February 22, 2018: Journal of Public Health Management and Practice: JPHMP
Jill A Marsteller, Yea-Jen Hsu, Christine Gill, Zippora Kiptanui, Oludolapo A Fakeye, Lilly D Engineer, Donna Perlmutter, Niharika Khanna, Gail B Rattinger, Donald Nichols, Ilene Harris
OBJECTIVE: To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries' experiences and satisfaction with care; and (3) perceptions of providers. DESIGN: 4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries...
February 16, 2018: Medical Care
(no author information available yet)
Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions...
February 20, 2018: Journal of Managed Care & Specialty Pharmacy
Nathan D Shippee, Angela Mattson, RoxAnne Brennan, John Huxsahl, Marcie L Billings, Mark D Williams
OBJECTIVE: Depression is common among adolescents, but many lack ready access to mental health services. Integrated models of care for depression are needed, along with evidence to support their use in regular practice. The authors examined the effectiveness of an ongoing collaborative care program for depressed adolescents embedded in a busy primary care practice. METHODS: This retrospective cohort study assessed EMERALD (Early Management and Evidence-based Recognition of Adolescents Living with Depression), a collaborative care program...
February 15, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Joshua R Niska, Sameer R Keole, Barbara A Pockaj, Michele Y Halyard, Samir H Patel, Donald W Northfelt, Richard J Gray, Nabil Wasif, Carlos E Vargas, William W Wong
Background: Recent trials in early-stage breast cancer support hypofractionated whole-breast radiotherapy (WBRT) as part of breast-conserving therapy (BCT). Evidence also suggests that radiotherapy (RT) omission may be reasonable for some patients over 70 years. Among radiation-delivery techniques, intensity-modulated RT (IMRT) is more expensive than 3-dimensional conformal RT (3DCRT). Based on this evidence, in 2013, the American Society for Radiation Oncology (ASTRO) recommended hypofractionated schedules for women aged ≥50 years with early-stage breast cancer and avoiding routine use of IMRT for WBRT...
2018: Breast Cancer: Targets and Therapy
Darren Shannon, Finbarr Murphy, Martin Mullins, Julian Eggert
An extensive number of research studies have attempted to capture the factors that influence the severity of vehicle impacts. The high number of risks facing all traffic participants has led to a gradual increase in sophisticated data collection schemes linking crash characteristics to subsequent severity measures. This study serves as a departure from previous research by relating injuries suffered in road traffic accidents to expected trauma compensation payouts and deriving a quantitative cost function. Data from the National Highway Traffic Safety Administration's (NHTSA) Crash Injury Research (CIREN) database for the years 2005-2014 is combined with the Book of Quantum, an Irish governmental document that offers guidelines on the appropriate compensation to be awarded for injuries sustained in accidents...
February 9, 2018: Accident; Analysis and Prevention
Shannon E Gray, Behrooz Hassani-Mahmooei, Ian D Cameron, Elizabeth Kendall, Justin Kenardy, Alex Collie
Purpose To determine the incidence of employed people who try and fail to return-to-work (RTW) following a transport crash. To identify predictors of RTW failure. METHODS: A historical cohort study was conducted in the state of Victoria, Australia. People insured through the state-based compulsory third party transport accident compensation scheme were included. Inclusion criteria included date of crash between 2003 and 2012 (inclusive), age 15-70 years at the time of crash, sustained a non-catastrophic injury and received at least 1 day of income replacement...
February 12, 2018: Journal of Occupational Rehabilitation
Robert E Burke, Jacqueline Jones, Emily Lawrence, Amy Ladebue, Roman Ayele, Chelsea Leonard, Brandi Lippmann, Daniel D Matlock, Rebecca Allyn, Ethan Cumbler
BACKGROUND: Despite a national focus on post-acute care brought about by recent payment reforms, relatively little is known about how hospitalized older adults and their caregivers decide whether to go to a skilled nursing facility (SNF) after hospitalization. OBJECTIVE: We sought to understand to what extent hospitalized older adults and their caregivers are empowered to make a high-quality decision about utilizing an SNF for post-acute care and what contextual or process elements led to satisfaction with the outcome of their decision once in SNF...
February 9, 2018: Journal of General Internal Medicine
Joshua A Rolnick, Kira L Ryskina
Medicare reimbursement for hospitals is increasingly tied to performance. The use of individual provider performance reports offers the potential to improve clinical outcomes through social comparison, and isolated cases of clinical dashboard uses at specific institutions have been previously reported. However, little is known about overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance. We used data from 2013 to 2015 from the American Hospital Association (AHA) Annual Survey Information Technology Supplement, which asked hospitals if they have used electronic data to create performance profiles...
February 7, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Arnold J Greenspon, Elizabeth L Eby, Allison A Petrilla, M Rizwan Sohail
BACKGROUND: Cardiac implantable electronic device (CIED) infection is a serious adverse event, but there are limited contemporary real-world data on treatment pathways and associated costs in the Medicare population following diagnosis of CIED infection. Hence, this study evaluates post-infection treatment pathways and associated healthcare expenditures and mortality among Medicare fee-for service (FFS) beneficiaries with CIED infection. METHODS: Retrospective cohort analysis of 5,401 beneficiaries who developed a device-related infection in the year following implantation/upgraded CIED (1/1/2010-12/31/2012)...
February 6, 2018: Pacing and Clinical Electrophysiology: PACE
Ladan Golestaneh
Hospitalizations drive up to 35% of the astronomical costs of care for patients on hemodialysis and are associated with poor outcomes. We describe outpatient care-sensitive categories of hospitalization risks in an effort to engage stakeholders and patients, as stakeholders, in mitigating hospitalizations. These categories include: (1) fluid (interdialytic weight gain (IDWG) and chronic volume status), (2) infection (vascular access and malnutrition/inflammation resilience), and c) psychosocial (poor social support, poor self-efficacy, and mood disorders) risks...
February 6, 2018: Seminars in Dialysis
Chrisanne Wilks, Erik Krisle, Kimberly Westrich, Kristina Lunner, David Muhlestein, Robert Dubois
BACKGROUND: Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather data on the actions accountable care organizations (ACOs) have taken to optimize medication use. OBJECTIVES: To (a) assess how ACOs optimize medication use; (b) establish an association between efforts to optimize medication use and achievement on financial and quality metrics; (c) identify organizational factors that correlate with optimized medication use; and (d) identify barriers to optimized medication use...
May 30, 2017: Journal of Managed Care & Specialty Pharmacy
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