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Bundled payments

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https://www.readbyqxmd.com/read/29029354/cost-analysis-of-sending-routine-pathology-specimens-following-total-joint-arthroplasty-in-the-age-of-bundled-payments
#1
Hayden S Holbrook, Johannes F Plate, Maxwell K Langfitt, Jason E Lang, John S Shields
Bundled payment plans are being developed as a means to curb healthcare spending. Routine histology following total hip arthroplasties (THA) and total knee arthroplasties (TKA) is standard practice at many institutions. Recently, the value of this practice has been questioned as histologic diagnoses in THA and TKA rarely differ from the clinical diagnoses. The goal of this study is to identify discrepant and discordant diagnoses following THA and TKA at an academic medical center and to calculate the cost-saving potential in the setting of a bundled payment plan...
October 12, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/29021109/design-and-impact-of-bundled-payment-for-detox-and-follow-up-care
#2
Amity E Quinn, Dominic Hodgkin, Jennifer N Perloff, Maureen T Stewart, Mary Brolin, Nancy Lane, Constance M Horgan
INTRODUCTION: Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients' utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States. Bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs...
November 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/29017802/big-data-and-total-hip-arthroplasty-how-do-large-databases-compare
#3
Nicholas A Bedard, Andrew J Pugely, Michael A McHugh, Nathan R Lux, Kevin J Bozic, John J Callaghan
BACKGROUND: Use of large databases for orthopedic research has become extremely popular in recent years. Each database varies in the methods used to capture data and the population it represents. The purpose of this study was to evaluate how these databases differed in reported demographics, comorbidities, and postoperative complications for primary total hip arthroplasty (THA) patients. METHODS: Primary THA patients were identified within National Surgical Quality Improvement Programs (NSQIP), Nationwide Inpatient Sample (NIS), Medicare Standard Analytic Files (MED), and Humana administrative claims database (HAC)...
September 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28983220/similar-cost-savings-of-bundled-payment-initiatives-applied-to-lower-extremity-total-joint-arthroplasty-can-be-achieved-applying-both-models-2-and-3
#4
Allyson Alfonso, Lorraine Hutzler, Bill Robb, Chad Beste, André Blom, Joseph Bosco
BACKGROUND: In an effort to control cost and increase value, Medicare is transitioning from fee-for-service to value-based alternative payment models (APMs). The Bundled Payments for Care Improvement (BPCI) initiative represents one such voluntary APM. BPCI offers four different bundling options: model 1 covers all Diagnosis Related Groups (DRGs) and Models 2-4 cover 48 clinical episodes, including 186 separate DRGs. QUESTIONS/PURPOSES: The purpose of this investigation is to analyze and compare the cost savings achieved by two different BPCI program participants, provider A and provider B, enrolled in different models of BPCI (Models 2 and 3) for lower extremity joint replacements (LEJRs)...
October 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
https://www.readbyqxmd.com/read/28963147/episodic-payments-bundling-part-i
#5
REVIEW
D J Jacofsky
Episodic, or bundled payments, is a concept now familiar to most in the healthcare arena, but the models are often misunderstood. Under a traditional fee-for-service model, each provider bills separately for their services which creates financial incentives to maximise volumes. Under a bundled payment, a single entity, often referred to as a convener (maybe the hospital, the physician group, or a third party) assumes the risk through a payer contract for all services provided within a defined episode of care, and receives a single (bundled) payment for all services provided for that episode...
October 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28963077/payment-and-care-for-hematopoietic-cellular-transplant-patients-toward-a-specialized-medical-home-for-complex-care-patients
#6
James L Gajewski, Mark B McClellan, Navneet S Majhail, Parameswaran N Hari, Christopher N Bredeson, Richard T Maziarz, Charles F LeMaistre, Michael C Lill, Stephanie H Farnia, Krishna V Komanduri, Michael J Boo
Patient-centered medical home models are fundamental to the advanced alternative payment models (APM) defined in the Medicare Access and Children's Health Insurance Plan (CHIP) Reauthorization Act (MACRA). The patient-centered medical home is a model of health care delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time...
September 26, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28930760/medical-education-and-health-care-delivery-a-call-to-better-align-goals-and-purposes
#7
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/28927566/low-rates-of-adverse-events-following-ambulatory-outpatient-total-hip-arthroplasty-at-a-free-standing-surgery-center
#8
Patrick C Toy, Matthew N Fournier, Thomas W Throckmorton, William M Mihalko
BACKGROUND: We proposed to determine the complication and hospital admission rates for patients with total hip arthroplasty (THA) done by a single surgeon in a stand-alone ambulatory surgical center with same-day discharge. Given the recent emphasis on bundled payments for a 90-day episode of care, this same time frame after surgery was chosen to determine patient outcomes. METHODS: The records of patients with THAs done through a direct anterior approach by a single surgeon at 2 separate ambulatory surgery centers were reviewed...
August 26, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28916895/the-cost-of-conversion-in-robotic-and-laparoscopic-colorectal-surgery
#9
Robert K Cleary, Andrew J Mullard, Jane Ferraro, Scott E Regenbogen
BACKGROUND: Conversion from minimally invasive to open colorectal surgery remains common and costly. Robotic colorectal surgery is associated with lower rates of conversion than laparoscopy, but institutions and payers remain concerned about equipment and implementation costs. Recognizing that reimbursement reform and bundled payments expand perspectives on cost to include the entire surgical episode, we evaluated the role of minimally invasive conversion in total payments. METHODS: This is an observational study from a linked data registry including clinical data from the Michigan Surgical Quality Collaborative and payment data from the Michigan Value Collaborative between July 2012 and April 2015...
September 15, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28916216/coronary-artery-bypass-grafting-bundled-payment-proposal-will-have-significant-financial-impact-on-hospitals
#10
Robert B Hawkins, J Hunter Mehaffey, Kenan W Yount, Leora T Yarboro, Clifford Fonner, Irving L Kron, Mohammed Quader, Alan Speir, Jeffrey Rich, Gorav Ailawadi
OBJECTIVES: The Centers for Medicare and Medicaid Services plans to institute a 5-year trial of bundled payments for coronary artery bypass grafting through 90 days after discharge. To investigate the impact, we reviewed actual inpatient costs for patients undergoing bypass surgery relative to the target price. METHODS: A total of 13,276 Medicare patients with estimated cost data underwent isolated coronary artery bypass grafting from 2008 to 2015 in 18 hospitals over 8 Medicare-defined regions within the Commonwealth of Virginia...
July 29, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28899901/do-the-stars-align-distribution-of-high-quality-ratings-of-healthcare-sectors-across-us-markets
#11
Jose Figueroa, Yevgeniy Feyman, Daniel Blumenthal, Ashish Jha
BACKGROUND: The US government created five-star rating systems to evaluate hospital, nursing homes, home health agency and dialysis centre quality. The degree to which quality is a property of organisations versus geographical markets is unclear. OBJECTIVES: To determine whether high-quality healthcare service sectors are clustered within US healthcare markets. DESIGN: Using data from the Centers for Medicare and Medicaid Services' Hospital, Dialysis, Nursing Home and Home Health Compare databases, we calculated the mean star ratings of four healthcare sectors in 304 US hospital referral regions (HRRs)...
September 12, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28885293/surgeon-reimbursement-relative-to-hospital-payments-for-spinal-fusion-trends-from-10-year-medicare-analysis
#12
Nikhil Jain, Frank M Phillips, Adam L Shimer, Safdar N Khan
STUDY DESIGN: Retrospective, economic analysis OBJECTIVE.: To analyze the trend in hospital charge and payment adjusted to corresponding surgeon charge and payment for cervical and lumbar fusions in a Medicare sample population from 2005-2014. SUMMARY OF BACKGROUND DATA: Previous studies have reported trends and variation in hospital charges and payments for spinal fusion, but none have incorporated surgeon data in analysis. Knowledge of the fiscal relationship between hospitals and surgeons over time will be important for stakeholders as we move toward bundled payments...
September 6, 2017: Spine
https://www.readbyqxmd.com/read/28885288/early-effects-of-medicare-s-bundled-payment-for-care-improvement-bpci-program-for-lumbar-fusion
#13
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/28870300/enhancing-recovery-after-total-knee-arthroplasty
#14
REVIEW
Richard W Rutherford, Jason M Jennings, Douglas A Dennis
There have been multiple successful efforts to improve and shorten the recovery period after elective total joint arthroplasty. The development of rapid recovery protocols through a multidisciplinary approach has occurred in recent years to improve patient satisfaction as well as outcomes. Bundled care payment programs and the practice of outpatient total joint arthroplasty have provided additional pressure and incentives for surgeons to provide high-quality care with low cost and complications. In this review, the evidence for modern practices are reviewed regarding patient selection and education, anesthetic techniques, perioperative pain management, intraoperative factors, blood management, and postoperative rehabilitation...
October 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28837458/early-lessons-on-bundled-payment-at-an-academic-medical-center
#15
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/28836222/the-implementation-of-managed-entry-agreements-in-central-and-eastern-europe-findings-and-implications
#16
Alessandra Ferrario, Diāna Arāja, Tomasz Bochenek, Tarik Čatić, Dávid Dankó, Maria Dimitrova, Jurij Fürst, Ieva Greičiūtė-Kuprijanov, Iris Hoxha, Arianit Jakupi, Erki Laidmäe, Olga Löblová, Ileana Mardare, Vanda Markovic-Pekovic, Dmitry Meshkov, Tanja Novakovic, Guenka Petrova, Maciej Pomorski, Dominik Tomek, Luka Voncina, Alan Haycox, Panos Kanavos, Patricia Vella Bonanno, Brian Godman
BACKGROUND: Managed entry agreements (MEAs) are a set of instruments to facilitate access to new medicines. This study surveyed the implementation of MEAs in Central and Eastern Europe (CEE) where limited comparative information is currently available. METHOD: We conducted a survey on the implementation of MEAs in CEE between January and March 2017. RESULTS: Sixteen countries participated in this study. Across five countries with available data on the number of different MEA instruments implemented, the most common MEAs implemented were confidential discounts (n = 495, 73%), followed by paybacks (n = 92, 14%), price-volume agreements (n = 37, 5%), free doses (n = 25, 4%), bundle and other agreements (n = 19, 3%), and payment by result (n = 10, >1%)...
August 23, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28832865/drivers-of-payment-variation-in-90-day-coronary-artery-bypass-grafting-episodes
#17
Vinay Guduguntla, John D Syrjamaki, Chad Ellimoottil, David C Miller, Richard L Prager, Edward C Norton, Patricia Theurer, Donald S Likosky, James M Dupree
Importance: Coronary artery bypass grafting (CABG) is scheduled to become a mandatory Medicare bundled payment program in January 2018. A contemporary understanding of 90-day CABG episode payments and their drivers is necessary to inform health policy, hospital strategy, and clinical quality improvement activities. Furthermore, insight into current CABG payments and their variation is important for understanding the potential effects of bundled payment models in cardiac care. Objective: To examine CABG payment variation and its drivers...
August 23, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28822501/baptist-health-system-succeeding-in-bundled-payments-through-behavioral-principles
#18
Joshua M Liao, Amanda Holdofski, Gary L Whittington, Michael Zucker, Sergio Viroslav, David L Fox, Amol S Navathe
No abstract text is available yet for this article.
September 2017: Healthcare
https://www.readbyqxmd.com/read/28818283/understanding-readmissions-following-operations-of-the-thyroid-and-parathyroid-glands
#19
Karole Collier, John Sataloff, Chris Wirtalla, Lindsay Kuo, Giorgos C Karakousis, Rachel R Kelz
BACKGROUND: In anticipation of bundled-payment models for thyroid and parathyroid disease, a better understanding of resource utilization following surgery is required. We sought to characterize the use of hospital services following such operations using an analysis of readmissions. METHODS: Patients age 18+years who underwent a thyroid or parathyroid operation in CA or NY (2008-2011) were classified by procedure type. Primary outcome was readmission within 90 days...
September 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28817444/strategies-for-reducing-population-surgical-costs-in-medicare-local-referrals-to-low-cost-hospitals
#20
Hari Nathan, Jyothi R Thumma, Edward C Norton, Justin B Dimick
OBJECTIVE: We sought to assess hospital cost variation for elective inpatient surgical procedures within small geographic areas. SUMMARY BACKGROUND DATA: Previous studies have documented cost variation for inpatient surgical procedures on a national basis, suggesting opportunities for savings. Cost variation within small geographic areas is more relevant to policymakers, providers, and patients, but it has not been studied. METHODS: Using Medicare payment data, we identified elderly patients undergoing 1 of 7 elective inpatient surgical procedures during 2010-2012...
August 16, 2017: Annals of Surgery
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