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Bundled payments

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https://www.readbyqxmd.com/read/28074438/is-there-variation-in-procedural-utilization-for-lumbar-spine-disorders-between-a-fee-for-service-and-salaried-healthcare-system
#1
Andrew J Schoenfeld, Heeren Makanji, Wei Jiang, Tracey Koehlmoos, Christopher M Bono, Adil H Haider
BACKGROUND: Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. QUESTIONS/PURPOSES: (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? METHODS: Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006-2014) were identified...
January 10, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28069851/less-intense-postacute-care-better-outcomes-for-enrollees-in-medicare-advantage-than-those-in-fee-for-service
#2
Peter J Huckfeldt, José J Escarce, Brendan Rabideau, Pinar Karaca-Mandic, Neeraj Sood
Traditional fee-for-service (FFS) Medicare's prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure...
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28068138/payment-reform-in-the-patient-centered-medical-home-enabling-and-sustaining-integrated-behavioral-health-care
#3
Benjamin F Miller, Kaile M Ross, Melinda M Davis, Stephen P Melek, Roger Kathol, Patrick Gordon
The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet...
January 2017: American Psychologist
https://www.readbyqxmd.com/read/28060238/single-institution-early-experience-with-the-bundled-payments-for-care-improvement-initiative
#4
Richard Iorio, Joseph Bosco, James Slover, Yousuf Sayeed, Joseph D Zuckerman
The Centers for Medicare & Medicaid Services (CMS) implemented the Bundled Payments for Care Improvement (BPCI) initiative in 2011. Through BPCI, organizations enlisted into payment agreements that include both performance and financial accountability for episodes of care. To succeed, BPCI requires quality maintenance and care delivery at lower costs. This necessitates physicians and hospitals to merge interests. Orthopaedic surgeons must assume leadership roles in cost containment, surgical safety, and quality assurance to deliver cost-effective care...
January 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28060228/risk-adjusted-hospital-outcomes-in-medicare-total-joint-replacement-surgical-procedures
#5
Donald E Fry, Michael Pine, Susan M Nedza, David G Locke, Agnes M Reband, Gregory Pine
BACKGROUND: Comparative measurement of hospital outcomes can define opportunities for care improvement and will assume great importance as alternative payment models for inpatient total joint replacement surgical procedures are introduced. The purpose of this study was to develop risk-adjusted models for Medicare inpatient and post-discharge adverse outcomes in elective lower-extremity total joint replacement and to apply these models for hospital comparison. METHODS: Hospitals with ≥50 qualifying cases of elective total hip replacement and total knee replacement from the Medicare Limited Data Set database of 2010 to 2012 were studied...
January 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28059916/does-hospital-transfer-impact-outcomes-after-colorectal-surgery
#6
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/28055062/cost-of-joint-replacement-using-bundled-payment-models
#7
Amol S Navathe, Andrea B Troxel, Joshua M Liao, Nan Nan, Jingsan Zhu, Wenjun Zhong, Ezekiel J Emanuel
Importance: Medicare launched the mandatory Comprehensive Care for Joint Replacement bundled payment model in 67 urban areas for approximately 800 hospitals following its experience in the voluntary Acute Care Episodes (ACE) and Bundled Payments for Care Improvement (BPCI) demonstration projects. Little information from ACE and BPCI exists to guide hospitals in redesigning care for mandatory joint replacement bundles. Objective: To analyze changes in quality, internal hospital costs, and postacute care (PAC) spending for lower extremity joint replacement bundled payment episodes encompassing hospitalization and 30 days of PAC...
January 3, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28034774/the-use-of-the-risk-assessment-and-prediction-tool-in-surgical-patients-in-a-bundled-payment-program
#8
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...
December 26, 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/28005410/results-of-a-medicare-bundled-payments-for-care-improvement-initiative-for-copd-readmissions
#9
Surya P Bhatt, J Michael Wells, Anand S Iyer, deNay P Kirkpatrick, Trisha M Parekh, Lauren T Leach, Erica M Anderson, J Greg Sanders, Jessica K Nichols, Cindy C Blackburn, Mark T Dransfield
RATIONALE: Approximately 20% of Medicare beneficiaries hospitalized for acute exacerbations of COPD are readmitted within 30 days of discharge. In addition to implementing penalties for excess readmissions, the United States Centers for Medicare & Medicaid Services (CMS) has developed Bundled Payments for Care Improvement (BPCI) initiatives to improve outcomes and control costs. OBJECTIVES: To evaluate whether a comprehensive COPD multidisciplinary intervention focusing on inpatient, transitional and outpatient care as part of our institution's BPCI participation initiative would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs...
December 22, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27984445/economic-impact-of-non-modifiable-risk-factors-in-orthopaedic-fracture-care-is-bundled-payment-feasible
#10
Lorraine Hutzler, Richard S Yoon, Siddharth A Mahure, Joseph A Bosco
OBJECTIVES: To determine if bundled payments are feasible in the orthopaedic fracture setting and the potential economic implications of this reimbursement structure. DESIGN: Prospective SETTING:: Multicenter PATIENTS/PARTICIPANTS:: Between 2004 - 2014, A total of 23,643 operatively treated fracture patients and 544,067 total joint arthroplasty patients were identified using the New York State SPARCS Database. INTERVENTIONS: Severity of Illness (SOI), hospital charges ($USD), length of stay (days), discharge disposition (homebound vs not) were collected...
November 16, 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27926675/improvement-in-total-joint-replacement-quality-metrics-year-one-versus-year-three-of-the-bundled-payments-for-care-improvement-initiative
#11
John M Dundon, Joseph Bosco, James Slover, Stephen Yu, Yousuf Sayeed, Richard Iorio
BACKGROUND: In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27919450/development-and-validation-of-a-prediction-model-for-patients-discharged-to-post-acute-care-after-colorectal-cancer-surgery
#12
Elizabeth A Bailey, Rebecca L Hoffman, Christopher Wirtalla, Giorgos Karakousis, Rachel R Kelz
BACKGROUND: As payment shifts toward bundled reimbursement, decreasing unnecessary inpatient care may provide cost savings. This study examines the association between discharge status, hospital duration of stay, and cost for colorectal operation patients without complications and uses risk factors to predict the need for post-acute care. METHODS: We used the New York Statewide Planning and Research Cooperative System and the California Healthcare Cost and Utilization Project State Inpatient Databases to identify all patients who underwent operative resection for colorectal cancer in 2009-2010 and were discharged to home or post-acute care...
December 2, 2016: Surgery
https://www.readbyqxmd.com/read/27917479/hospital-postacute-care-referral-networks-is-referral-concentration-associated-with-medicare-style-bundled-payments
#13
Ramandeep Kaur, Jennifer N Perloff, Christopher Tompkins, Christine E Bishop
OBJECTIVE: To evaluate whether Medicare-style bundled payments are lower or higher for beneficiaries discharged from hospitals with postacute care (PAC) referrals concentrated among fewer PAC providers. DATA SOURCE: Medicare Part A and Part B claim (2008-2012) for all beneficiaries residing in any of 17 market areas: the Provider of Service file, the Healthcare Cost Report Information System, and the Dartmouth Atlas. STUDY DESIGN: An observational study in which hospitals were distinguished according to PAC referral concentration, which is the tendency to utilize fewer rather than more PAC providers...
December 5, 2016: Health Services Research
https://www.readbyqxmd.com/read/27890309/patterns-of-ninety-day-readmissions-following-total-joint-replacement-in-a-bundled-payment-initiative
#14
Omar A Behery, Benjamin S Kester, Jarrett Williams, Joseph A Bosco, James D Slover, Richard Iorio, Ran Schwarzkopf
BACKGROUND: Alternative payment models aim to improve quality and decrease costs associated with total joint replacement. Postoperative readmissions within 90 days are of interest to clinicians and administrators as there is no additional reimbursement beyond the episode bundled payment target price. The aim of this study is to improve the understanding of the patterns of readmission which would better guide perioperative patient management affecting readmissions. We hypothesize that readmissions have different timing, location, and patient health profile patterns based on whether the readmission is related to a medical or surgical diagnosis...
November 1, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27871497/possible-consequences-of-regionally-based-bundled-payments-for-diabetic-amputations-for-safety-net-hospitals-in-texas
#15
Karina Newhall, David Stone, Ryan Svoboda, Philip Goodney
OBJECTIVE: Ongoing health reform in the United States encourages quality-based reimbursement methods such as bundled payments for surgery. The effect of such changes on high-risk procedures is unknown, especially at safety net hospitals. This study quantified the burden of diabetes-related amputation and the potential financial effect of bundled payments at safety net hospitals in Texas. METHODS: We performed a cross-sectional analysis of diabetic amputation burden and charges using publically available data from Centers for Medicare and Medicaid and the Texas Department of Health from 2008 to 2012...
December 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27870676/bundled-payments-for-care-improvement-lessons-learned-in-the-first-year
#16
Peter L Althausen, Lisa Mead
The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27870671/surgeon-attitudes-regarding-the-use-of-generic-implants-an-ota-survey-study
#17
Justin A Walker, Peter L Althausen
OBJECTIVES: To determine the role of generic orthopaedic trauma implants in the current orthopaedic trauma market, as perceived by OTA members, and investigate potential hurdles to the use of generic implants and other cost-containment measures. DESIGN: Survey study. SETTING: Not applicable. PARTICIPANTS: All active OTA members with valid e-mail addresses were invited to participate. INTERVENTION: Participants completed a brief online survey with questions regarding participation in cost-containment and incentive programs, industry relationships, generic implant use, and the role of surgeons in cost containment...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27869620/safety-and-outcomes-of-inpatient-compared-with-outpatient-surgical-procedures-for-ankle-fractures
#18
Charles Qin, Robert G Dekker, Jordan T Blough, Anish R Kadakia
BACKGROUND: As the cost of health-care delivery rises in the era of bundled payments for care, there is an impetus toward minimizing hospitalization. Evidence to support the safety of open reduction and internal fixation (ORIF) of ankle fractures in the outpatient setting is largely anecdotal. METHODS: Patients who underwent ORIF from 2005 to 2013 were identified via postoperative diagnoses of ankle fracture and Current Procedural Terminology codes; patients with open fractures and patients who were emergency cases were excluded...
October 19, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27865568/home-discharge-after-primary-elective-total-joint-arthroplasty-postdischarge-complication-timing-and-risk-factor-analysis
#19
Dong-Han Yao, Aakash Keswani, Chirag K Shah, Alex Sher, Karl M Koenig, Calin S Moucha
BACKGROUND: Bundled payment programs for primary total joint arthroplasty (TJA) have identified reducing nonhome discharge as a major area of cost savings. Health care providers must therefore identify, risk stratify, and appropriately care for home-discharged TJA patients. This study aimed to analyze risk factors and timing of postdischarge complications among home-discharged primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients and risk stratify them to identify those who would benefit from higher level care...
August 27, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27846324/count-on-this-no-matter-who-wins-the-election
#20
EDITORIAL
John Hickner
The Accountable Care Organization demonstrations around the country have shown that some, but not all, health care organizations are able to bend the steep cost incline downward using incentives, bundled payments, excellent primary care access, and care coordination.
October 2016: Journal of Family Practice
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