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Cardiac surgery bundled payments

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https://www.readbyqxmd.com/read/28412109/reengineering-valve-patients-postdischarge-management-for-adapting-to-bundled-payment-models
#1
Michael S Koeckert, Patricia A Ursomanno, Mathew R Williams, Michael Querijero, Elias A Zias, Didier F Loulmet, Kevin Kirchen, Eugene A Grossi, Aubrey C Galloway
BACKGROUND: Bundled Payments for Care Improvement (BPCI) initiatives were developed by Medicare in an effort to reduce expenditures while preserving quality of care. Payment model 2 reimburses based on a target price for 90-day episode of care postprocedure. The challenge for valve patients is the historically high (>35%) 90-day readmission rate. We analyzed our institutional cardiac surgical service line adaptation to this initiative. METHODS: On May 1, 2015, we instituted a readmission reduction initiative (RRI) that included presurgical risk stratification, comprehensive predischarge planning, and standardized postdischarge management led by cardiac nurse practitioners (CNPs) who attempt to guide any postdischarge encounters (PDEs)...
July 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28369885/medicare-s-acute-care-episode-demonstration-effects-of-bundled-payments-on-costs-and-quality-of-surgical-care
#2
Lena M Chen, Andrew M Ryan, Terry Shih, Jyothi R Thumma, Justin B Dimick
OBJECTIVE: To evaluate whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program-an early, small, voluntary episode-based payment program-was associated with a change in expenditures or quality of care. DATA SOURCES/STUDY SETTING: Medicare claims for patients who underwent cardiac or orthopedic surgery from 2007 to 2012 at ACE or control hospitals. STUDY DESIGN: We used a difference-in-differences approach, matching on baseline and pre-enrollment volume, risk-adjusted Medicare payments, and clinical outcomes to identify controls...
March 28, 2017: Health Services Research
https://www.readbyqxmd.com/read/28111178/risk-factors-for-and-timing-of-adverse-events-after-total-shoulder-arthroplasty
#3
Andrew J Lovy, Aakash Keswani, Christina Beck, James E Dowdell, Bradford O Parsons
BACKGROUND: Total shoulder arthroplasty (TSA) is a likely target for future bundled payment initiatives, necessitating accurate preoperative risk stratification. The purpose of this study was to identify risk factors for unplanned readmission and severe adverse events, to risk stratify TSA patients based on these risk factors, and to assess timing of complications after TSA. METHODS: Data were collected from patients undergoing TSA from 2009 to 2014 in the American College of Surgeons National Surgical Quality Improvement Program...
January 19, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28059916/does-hospital-transfer-impact-outcomes-after-colorectal-surgery
#4
Christopher J Chow, Wolfgang B Gaertner, Christine C Jensen, Bradford Sklow, Robert D Madoff, Mary R Kwaan
BACKGROUND: With increasing public reporting of outcomes and bundled payments, hospitals and providers are scrutinized for morbidity and mortality. The impact of patient transfer before colorectal surgery has not been well characterized in a risk-adjusted fashion. OBJECTIVE: We hypothesized that hospital-to-hospital transfer would independently predict morbidity and mortality beyond traditional predictor variables. DESIGN: We constructed a retrospective cohort of 158,446 patients who underwent colorectal surgery using the 2009-2013 American College of Surgeons National Surgical Quality Improvement Program database...
February 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28034774/the-use-of-the-risk-assessment-and-prediction-tool-in-surgical-patients-in-a-bundled-payment-program
#5
James Slover, Kathleen Mullaly, Raj Karia, John Bendo, Patricia Ursomanno, Aubrey Galloway, Richard Iorio, Joseph Bosco
OBJECTIVES: The purpose of this study was to evaluate the relationship between the Risk Assessment and Predictor Tool (RAPT) and patient discharge disposition in an institution participating in bundled payment program for total joint replacement, spine fusion and cardiac valve surgery patients. METHOD: Between April 2014 and April 2015, RAPT scores of 767 patients (535 primary unilateral total joint arthroplasty; 150 cardiac valve replacement; 82 spinal fusions) were prospectively captured...
February 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/26886810/taking-risk-early-results-from-teaching-hospitals-participation-in-the-center-for-medicare-and-medicaid-innovation-bundled-payments-for-care-improvement-initiative
#6
Coleen Kivlahan, Janis M Orlowski, Jonathan Pearce, Jessica Walradt, Matthew Baker, Darrell G Kirch
The authors describe observations from the 27 teaching hospitals constituting the Association of American Medical Colleges (AAMC) cohort in the Center for Medicare and Medicaid Innovation (CMMI) Bundled Payments for Care Improvement (BPCI) initiative. CMMI introduced BPCI in August 2011 and selected the first set of participants in January 2013. BPCI participants enter into Medicare payment arrangements for episodes of care for which they take financial risk. The first round of participants entered risk agreements on October 1, 2013 and January 1, 2014...
July 2016: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/26209483/bundled-payments-in-cardiac-surgery-is-risk-adjustment-sufficient-to-make-it-feasible
#7
Kenan W Yount, James M Isbell, Casey Lichtendahl, Zachary Dietch, Gorav Ailawadi, Irving L Kron, John A Kern, Christine L Lau
BACKGROUND: Policymakers have proposed risk-adjusted bundled payment as the single most promising method of linking reimbursement to value rather than to quantity of service. Our objective was to assess the relationship between risk and cost to develop a model for forecasting the costs of cardiac operations under a bundled payment scheme. METHODS: All patients undergoing adult cardiac operations for which there was a Society of Thoracic Surgeons (STS) risk score over a 5-year period (2008 to 2013) at a tertiary care, university hospital were reviewed...
November 2015: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/8526673/integrated-cardiac-care
#8
G L Hallman, C Edmonds
In 1984 physicians at the Texas Heart Institute developed Cardiovascular Care Providers Inc, the first packaged-pricing plan for cardiovascular surgery. Under this arrangement, all services, including physician and hospital charges, are covered by a global payment package (bundled service). The resulting flat fee is lower than the sum of the individual charges. Since November 1984 the plan has been offered to the non-Medicare (less than 65 years old) population through contracts with self-insured corporations, prepaid health plans, union trusts, and foreign governments...
November 1995: Annals of Thoracic Surgery
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