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Bundled payments

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https://www.readbyqxmd.com/read/29223321/is-there-value-in-retrospective-90-day-bundle-payment-models-for-shoulder-arthroplasty-procedures
#1
Susan M Odum, Nady Hamid, Bryce A Van Doren, Leo R Spector
BACKGROUND: The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative was implemented as part of the Affordable Care Act. We implemented a retrospective payment model 2 for a 90-day total shoulder arthroplasty (TSA) episode to assess the value of TSA BPCI at our private practice. METHODS: Expenditures and postacute event rates of 132 fee-for-service (FFS) patients who underwent a TSA operation between 2009 and 2012 were compared with 333 BPCI patients who had a TSA operation in 2015...
December 7, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29200351/risk-adjustment-may-lessen-penalties-on-hospitals-treating-complex-cardiac-patients-under-medicare-s-bundled-payments
#2
Adam A Markovitz, Chandy Ellimoottil, Devraj Sukul, Samyukta Mullangi, Lena M Chen, Brahmajee K Nallamothu, Andrew M Ryan
To reduce variation in spending, Medicare has considered implementing a cardiac bundled payment program for acute myocardial infarction and coronary artery bypass graft. Because the proposed program does not account for patient risk factors when calculating hospital penalties or rewards ("reconciliation payments"), it might unfairly penalize certain hospitals. We estimated the impact of adjusting for patients' medical complexity and social risk on reconciliation payments for Medicare beneficiaries hospitalized for the two conditions in the period 2011-13...
December 2017: Health Affairs
https://www.readbyqxmd.com/read/29194494/impact-of-bundled-payments-on-hip-fracture-outcomes-a-nationwide-population-based-study
#3
Yu-Chi Tung, Hsien-Yen Chang, Guann-Ming Chang
Objective: Establishing one price for all bundled services for a particular illness, which has become the key to healthcare reform efforts, is designed to encourage health professionals to coordinate their care for patients. Limited information is available, however, concerning whether bundled payments are associated with changes in patient outcomes. Nationwide longitudinal population-based data were used to examine the effect of bundled payments on hip fracture outcomes. Design: An interrupted time series design with a comparison group...
November 29, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29180300/variation-in-spending-around-surgical-episodes-of-urinary-stone-disease-findings-from-michigan
#4
Juan San Juan, Hechuan Hou, Khurshid R Ghani, James M Dupree, John M Hollingsworth
PURPOSE: To help rein in surgical spending, there is growing interest in the application of payment bundles to common outpatient procedures like ureteroscopy (URS) and shockwave lithotripsy (SWL). However, before urologists can move to such a payment system, they need to know where their episode costs are concentrated. MATERIALS AND METHODS: Using claims data from the Michigan Value Collaborative, we identified patients who underwent URS or SWL at hospitals in Michigan (2012 to 2015)...
November 24, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29180193/defining-payments-associated-with-the-treatment-of-colorectal-cancer
#5
Faiz Gani, Marcelo Cerullo, Joseph K Canner, Alison Conca-Cheng, Alan E Harzman, Syed G Husain, William C Cirocco, Mark W Arnold, Amber Traugott, Fabian M Johnston, Timothy M Pawlik
BACKGROUND: While bundled payments aim to reduce variations in health care spending across the continuum of care, data reporting on variations in payments for privately insured patients undergoing treatment for colon cancer (CC) are lacking. The current study sought to characterize variations in payments received for the treatment of CC using a cohort of commercially insured patients. METHODS: Patients who underwent a colectomy for CC were identified using the MarketScan Database for 2010-2014...
December 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29164990/implications-of-stroke-and-bleeding-risk-scores-and-comorbidities-on-episode-based-bundled-payments-for-patients-with-nonvalvular-atrial-fibrillation
#6
Scott Kaatz, Craig I Coleman, Brahim Bookhart, François Laliberté, Winnie W Nelson, Kip Brown, Silas Martin, Jeffrey Schein, Patrick Lefebvre
OBJECTIVES: Due to the high cost of nonvalvular atrial fibrillation (NVAF), this condition may be a suitable candidate for condition-specific bundled payments. This paper evaluates the healthcare cost of NVAF and uses common bleeding and stroke risk scores (HAS-BLED and CHA2DS2-VASc) to explore the risk-based healthcare cost differences among NVAF patients. METHODS: MarketScan claims of NVAF patients (ICD-9-CM code 427.31) were analyzed from 01/2010-04/2015. These claims feature more than 196 million covered lives and more than 300 contributing employers and 25 contributing health plans...
November 22, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29157539/physical-medicine-and-rehabilitation-value-in-bundled-payment-for-total-joint-replacement-and-cardiac-surgery-the-rusk-experience
#7
REVIEW
Steven R Flanagan, Jonathan Whiteson, Geoffrey Hall, Christopher J Standaert
No abstract text is available yet for this article.
November 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/29152607/use-of-post-acute-care-after-hospital-discharge-in-urban-and-rural-hospitals
#8
Robert E Burke, Christine D Jones, Eric A Coleman, Jason R Falvey, Jennifer E Stevens-Lapsley, Adit A Ginde
Objectives: Geographic variation in the use of post-acute care (PAC - skilled nursing facility and home health care) after hospital discharge is substantial, but reasons for this remain largely unexplored. PAC use in urban hospitals compared to rural hospitals may be one key contributor. We aimed to describe PAC use, explore substitution of one type of PAC for another, and identify how PAC use varies by diagnosis in urban and rural settings. Study Design: Secondary analysis of the 2012 National Inpatient Sample including adult discharges to PAC after a hospitalization...
March 2017: American Journal of Accountable Care
https://www.readbyqxmd.com/read/29147056/organizing-integrated-health-care-services-to-meet-older-people-s-needs
#9
Islene Araujo de Carvalho, JoAnne Epping-Jordan, Anne Margriet Pot, Edward Kelley, Nuria Toro, Jotheeswaran A Thiyagarajan, John R Beard
In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people's physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services...
November 1, 2017: Bulletin of the World Health Organization
https://www.readbyqxmd.com/read/29135882/early-effects-of-medicare-s-bundled-payment-for-care-improvement-bpci-program-for-lumbar-fusion
#10
Timothy S Carey, Darren DeWalt
No abstract text is available yet for this article.
November 10, 2017: Spine
https://www.readbyqxmd.com/read/29129345/defining-value-based-care-in-cardiac-and-vascular-anesthesiology-the-past-present-and-future-of-perioperative-cardiovascular-care
#11
REVIEW
Lavinia M Kolarczyk, Harendra Arora, Michael W Manning, David A Zvara, Robert S Isaak
Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes...
September 28, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29128234/skilled-nursing-facility-partnerships-may-decrease-90-day-costs-in-a-total-joint-arthroplasty-episode-under-the-bundled-payments-for-care-improvement-initiative
#12
Omar A Behery, Shalen Kouk, Kevin K Chen, Kathleen A Mullaly, Joseph A Bosco, James D Slover, Richard Iorio, Ran Schwarzkopf
BACKGROUND: The Bundled Payments for Care Improvement initiative was developed to reduce costs associated with total joint arthroplasty through a single payment for all patient care from index admission through a 90-day post-discharge period, including care at skilled nursing facilities (SNFs). The aim of this study is to investigate whether forming partnerships between hospitals and SNFs could lower the post-discharge costs. We hypothesize that institutionally aligned SNFs have lower post-discharge costs than non-aligned SNFs...
October 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29107491/readmission-reoperation-and-complications-total-hip-vs-total-knee-arthroplasty
#13
Jaiben George, Morad Chughtai, Anton Khlopas, Alison K Klika, Wael K Barsoum, Carlos A Higuera, Michael A Mont
BACKGROUND: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are currently grouped under the same Diagnosis-Related Group (DRG). With the introduction of bundled payments, providers are accountable for all the costs incurred during the episode of care, including the costs of readmissions and management of complications. However, it is unclear whether readmission rates and short-term complications are similar in primary THA and TKA. METHODS: The National Surgical Quality Improvement Project database was queried from 2011 to 2015 to identify 248,150 primary THA/TKA procedures using Current Procedural Terminology codes...
October 5, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29101960/market-evaluation-finances-bundled-payments-and-accountable-care-organizations
#14
REVIEW
Shazia Mehmood Siddique, Shivan J Mehta
To control costs and improve quality, changes in health care delivery and financing have emerged, resulting in shifting of financial risk to providers for the quality and cost of care, including emergence of accountable care organizations and bundled payment models. This article discusses health care financing and delivery models in the context of procedures and surgeries that happen outside of the operating room. It describes the history of health insurance, trends in ambulatory surgery centers, and new payment models that have emerged from the Affordable Care Act and the Medicare Access and Children's Health Insurance Program Reauthorization Act...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29071495/open-treatment-of-ankle-fracture-as-inpatient-increases-risk-of-complication
#15
Michelle S Shen, Ashley C Dodd, Nikita Lakomkin, Idine Mousavi, Catherine Bulka, A Alex Jahangir, Manish K Sethi
BACKGROUND: Ankle fracture is one of the most common injuries treated by orthopaedic surgeons, and its incidence is only expected to rise with an aging population. It is also associated with often costly complications, yet there is little literature on risk factors, especially modifiable ones, driving these complications. The aim of this study is to reveal whether inpatient treatment after ankle fracture is associated with higher incidence of postoperative complications. As the USA moves towards a bundled payment healthcare system, it is imperative that orthopaedists maximize patient outcome and quality of care while also reducing overall costs...
October 26, 2017: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
https://www.readbyqxmd.com/read/29064004/outpatient-total-joint-arthroplasty
#16
REVIEW
Jack M Bert, Jessica Hooper, Sam Moen
PURPOSE OF REVIEW: Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. RECENT FINDINGS: Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway...
December 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/29051001/episode-based-payment-variation-for-urological-cancer-surgery
#17
Chad Ellimoottil, Jonathan Li, Zaojun Ye, James M Dupree, Hye Sung Min, Deborah Kaye, Lindsey A Herrel, David C Miller
OBJECTIVE: To investigate payment variation for three common urological cancer surgeries and evaluate the potential for applying bundled payment programs to these procedures. METHODS: Using 2008-2011 Surveillance, Epidemiology, and End Results-Medicare linked data, we identified all beneficiaries aged greater than 65 years who underwent cystectomy, prostatectomy, or nephrectomy for cancer. Total episode payments were determined by aggregating hospital, professional, and post-acute care claims from the index surgical hospitalization through 90 days post-discharge...
October 16, 2017: Urology
https://www.readbyqxmd.com/read/29036028/appropriateness-of-the-use-of-mri-in-the-diagnosis-and-treatment-of-wrist-ligamentous-injury
#18
Brett F Michelotti, Alexandra Mathews, Kevin C Chung
BACKGROUND: When diagnosing wrist ligamentous injury, we hypothesize that MRI is used injudiciously and is associated with unnecessary cost. METHODS: A retrospective review was conducted of patients, ages 20-60 years, who underwent an MRI for possible wrist ligamentous injury at a tertiary care center between 2009 and 2014. Treatment recommendation was classified as non-operative, operative, or equivocal. If the MRI-directed treatment recommendation differed from the pre-MRI treatment recommendation, we noted that the MRI influenced patient care (impact study)...
October 12, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29029354/cost-analysis-of-sending-routine-pathology-specimens-following-total-joint-arthroplasty-in-the-age-of-bundled-payments
#19
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
#20
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
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