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"Value-based payment"

Richard G Malish
The Army transitioned to a Patient-Centered Medical Home concept for primary care beginning in 2011. In spite of organizational commitment to the paradigm, the transition has not been without pitfalls. This performance improvement project operated under the hypothesis that focusing on the market-based incentives of a capitated system would result in a quantum leap toward the Patient-Centered Medical Home ideal. Utilizing a simple teaching device to repetitively highlight clinic and provider behaviors incentivized in a value-based payment system, a single clinic achieved significant improvements in enrollment, patient satisfaction, and measures associated with prevention while assuming an identity as a "virtual clinic"...
October 2016: Military Medicine
Yangyang R Yu, Paulette I Abbas, Carolyn M Smith, Kathleen E Carberry, Hui Ren, Binita Patel, Jed G Nuchtern, Monica E Lopez
PURPOSE: As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. METHODS: Process maps were created using medical record time stamps...
September 15, 2016: Journal of Pediatric Surgery
Andrew B Rosenkrantz, C Matthew Hawkins
PURPOSE: The aim of this study was to evaluate the feasibility of using Twitter polls to assess public opinion regarding session content at a national specialty society meeting. METHODS: Twitter polls allow users to embed multiple-choice questions within tweets and automatically aggregate responses. Two radiologists attending the 2016 annual meeting of the ACR posted a Twitter poll containing the hashtag #ACR2016 during 10 meeting sessions addressing socioeconomics/advocacy, patient experience, and social media/informatics (20 polls total)...
September 24, 2016: Journal of the American College of Radiology: JACR
Laxmaiah Manchikanti, Standiford Helm Ii, Ramsin M Benyamin, Joshua A Hirsch
UNLABELLED: The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score...
September 2016: Pain Physician
Adam Lustig, Michael Ogden, Robert W Brenner, Jerry Penso, Kimberly D Westrich, Robert W Dubois
BACKGROUND: In 2013, it was reported that about 1 of every 3 U.S. adults has hypertension. Of these 70 million individuals, approximately 50% have their blood pressure under control. Achieving hypertension control, especially in at-risk populations, requires a multipronged approach that includes lifestyle modifications and pharmacological treatment. As provider groups, hospital systems, and integrated delivery networks optimize their care processes to promote population health activities in support of the accountable care organization (ACO) model of care, managing hypertension and other chronic diseases will be essential to their success...
October 2016: Journal of Managed Care & Specialty Pharmacy
J A Hirsch, T M Leslie-Mazwi, G N Nicola, M Bhargavan-Chatfield, D J Seidenwurm, E Silva, L Manchikanti
No abstract text is available yet for this article.
September 22, 2016: AJNR. American Journal of Neuroradiology
Gary M Kirsh
No abstract text is available yet for this article.
2016: Reviews in Urology
Roy A Beveridge, Laura E Happe, Mike Funk
Decades of practice under a system that set the financial interests of physicians and insurers at odds, has resulted in physician distrust of insurers being cited a key obstacle to value-based arrangements. Insurers must work to shift the insurer-provider relationship from one that's transactional to a partnership built on trust. Even when physicians and insurers agree philosophically on quality over quantity, there are practical challenges. Insurers can provide the data, systems and analytical insights that help inform the physician's care strategy...
September 2, 2016: Healthcare
John Kimberly, Imran Cronk
The world of health care is changing dramatically, as reflected in the number, magnitude, and scope of innovative new approaches-to how illness is treated and how better health is promoted-that are being implemented around the globe. The changes triggered by these initiatives affect both how care is organized, managed, and paid for and the kinds of approaches that are being developed to keep people healthy. Underlying these changes is a more fundamental paradigm shift, a shift in the priority given to "value" in the formulation of policy and management practice...
September 6, 2016: Annals of the New York Academy of Sciences
Karen E Joynt, Jose E Figueroa, John Oray, Ashish K Jha
OBJECTIVES: To determine the opinions of US hospital leadership on the Hospital Readmissions Reduction Program (HRRP), a national mandatory penalty-for-performance program. STUDY DESIGN: We developed a survey about federal readmission policies. We used a stratified sampling design to oversample hospitals in the highest and lowest quintile of performance on readmissions, and hospitals serving a high proportion of minority patients. METHODS: We surveyed leadership at 1600 US acute care hospitals that were subject to the HRRP, and achieved a 62% response rate...
2016: American Journal of Managed Care
Albert P Nguyen, Joseph A Hyder, Brendan T Wanta, Henry T Stelfox, Ulrich Schmidt
BACKGROUND: Performance measurement is essential for quality improvement and is inevitable in the shift to value-based payment. The National Quality Forum is an important clearinghouse for national performance measures in health care in the United States. AIM: We reviewed the National Quality Forum library of performance measures to highlight measures that are relevant to critical care medicine, and we describe gaps and opportunities for the future of performance measurement in critical care medicine...
June 23, 2016: Journal of Critical Care
Glyn Elwyn, Dominick L Frosch, Sarah Kobrin
BACKGROUND: The ethical argument that shared decision-making is "the right" thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, therefore, when evaluating new approaches such as shared decision-making to conceptualize potential consequences in a way that is broad, long-term, and as relevant as possible to multiple stakeholders...
2016: Implementation Science: IS
Joseph E Tanenbaum, Jacob A Miller, Vincent J Alentado, Daniel Lubelski, Benjamin P Rosenbaum, Edward C Benzel, Thomas E Mroz
BACKGROUND CONTEXT: The incidence of adverse care quality events among patients undergoing cervical fusion surgery is unknown using the definition of care quality employed by the Centers for Medicare and Medicaid Services (CMS). The effect of insurance status on the incidence of these adverse quality events is also unknown. PURPOSE: This study determined the incidence of hospital acquired conditions (HAC) and patient safety indicators (PSI) in cervical spine fusion patients and analyzed the association between primary payer status and these adverse events...
August 4, 2016: Spine Journal: Official Journal of the North American Spine Society
Jody Hill-Mischel, Walter W Morrissey, Kimberly Neese, Timothy R Shoger
A healthcare organization's efforts to strategically transform its cost structure in preparation for value-based payment invariably must begin with a systemwide assessment of cost and quality. Such an assessment should focus on three categories of performance improvement activities: margin improvement, business restructuring, and clinical transformation. A work-team approach is recommended, where teams with multidisciplinary representation assume responsibility for assessing specific areas (e.g., acute care enterprise, physician enterprise, business restructuring)...
June 2016: Healthcare Financial Management: Journal of the Healthcare Financial Management Association
Sabrina Teferi, Ronald Jackson, Richard E Wild
The US Department of Health and Human Services and the Centers for Medicare & Medicaid Services have announced goals and timelines to transition from payments based on volume to payments based on value, quality, and efficient delivery of care. These value-based payments and alternative payment models will impact all health care professionals and provider organizations by encouraging better care, healthier people, and spending health care dollars wisely and efficiently.
July 2016: North Carolina Medical Journal
Joshua M Liao, Ezekiel J Emanuel, Amol S Navathe
Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data...
September 2016: Healthcare
Jack M Colwill, John J Frey, Macaran A Baird, John W Kirk, Walter W Rosser
A group of senior leaders from the early generation of academic family medicine reflect on the meaning of being a personal physician, based on their own clinical experiences and as teachers of residents and students in academic health centers. Recognizing that changes in clinical care and education at national and local systems levels have added extraordinary demands to the role of the personal physician, the senior group offers examples of how the discipline might go forward in changing times. Differently organized care such as the Family Health Team model in Ontario, Canada; value-based payment for populations in large health systems; and federal changes in reimbursement for populations can have positive effects on physician satisfaction...
July 2016: Journal of the American Board of Family Medicine: JABFM
Merrill Goozner
No abstract text is available yet for this article.
April 11, 2016: Modern Healthcare
Laura Ramos Hegwer
Capital planning has become more centralized at many health systems. Managing the capital budget for IT continues to be a challenge. The arrival of value-based payment is influencing some organizations' strategic capital investments.
May 2016: Healthcare Financial Management: Journal of the Healthcare Financial Management Association
Barbara L Massoudi, Laura H Marcial, Elizabeth Tant, Julia Adler-Milstein, Suzanne L West
BACKGROUND: A key motivation for the large national investment in electronic health record systems is to promote electronic reporting of quality measures that can be used as the basis for moving to value-based payment. Given the fragmented delivery system, robust quality reporting requires aggregating data across sites of care. Health information exchanges (HIEs) have emerged to facilitate exchange of clinical data across provider organizations and, therefore, should be well-positioned to support clinical quality measure reporting...
June 2016: Healthcare
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