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"Bundled payment"

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https://www.readbyqxmd.com/read/28433428/effect-of-risk-acceptance-for-bundled-care-payments-on-clinical-outcomes-in-a-high-volume-total-joint-arthroplasty-practice-after-implementation-of-a-standardized-clinical-pathway
#1
James R Kee, Paul K Edwards, Charles L Barnes
BACKGROUND: The Bundled Payments for Care Improvement (BPCI) initiative and the Arkansas Payment Improvement (API) initiative seek to incentivize reduced costs and improved outcomes compared with the previous fee-for-service model. Before participation, our practice initiated a standardized clinical pathway (CP) to reduce length of stay (LOS), readmissions, and discharge to postacute care facilities. METHODS: This practice implemented a standardized CP focused on patient education, managing patient expectations, and maximizing cost outcomes...
March 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28420558/maternal-medical-complexity-impact-on-prenatal-health-care-spending-among-women-at-low-risk-for-cesarean-section
#2
Shayna D Cunningham, Carolina Herrera, Ifeyinwa E Udo, Katy B Kozhimannil, Eric Barrette, Urania Magriples, Jeannette R Ickovics
BACKGROUND: Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured. OBJECTIVE: The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery...
April 15, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28414044/the-impact-of-the-medicare-access-and-chip-reauthorization-act-macra-on-the-field-of-ophthalmology
#3
Brenton Kinker, Kaitlyn Dobesh, Nariman Nassiri, Mark S Juzych, M Roy Wilson
PURPOSE: To analyze the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on the field of ophthalmology. DESIGN: A perspective on the effects of MACRA's Quality Payment Program after analysis of the proposed rule, final rule, and commentary submitted by relevant stakeholders. RESULTS: Physicians will need to use one of two payment structures: Merit Based Incentive Payment Systems (MIPS), or Alternative Payment Models (APMs)...
April 13, 2017: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/28412109/reengineering-valve-patients-postdischarge-management-for-adapting-to-bundled-payment-models
#4
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)...
March 10, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28395006/association-between-hospitals-engagement-in-value-based-reforms-and-readmission-reduction-in-the-hospital-readmission-reduction-program
#5
Andrew M Ryan, Sam Krinsky, Julia Adler-Milstein, Cheryl L Damberg, Kristin A Maurer, John M Hollingsworth
Importance: Medicare is experimenting with numerous concurrent reforms aimed at improving quality and value for hospitals. It is unclear if these myriad reforms are mutually reinforcing or in conflict with each other. Objective: To evaluate whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare's Hospital Readmission Reduction Program (HRRP). Design, Setting, and Participants: Retrospective, longitudinal study using publicly available national data from Hospital Compare on hospital readmissions for 2837 hospitals from 2008 to 2015...
April 10, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28392029/improving-care-and-education-through-a-radiology-resident-driven-clinical-consultation-service
#6
Gayle R Salama, Courtney Sullivan, Daniel Holzwanger, Ashley E Giambrone, Robert J Min, Keith D Hentel
RATIONALE AND OBJECTIVE: As health care moves toward bundled payment systems and merit-based incentive models, increasing awareness of the value of the radiologist is essential. A resident-driven clinical imaging rounds (CIR) program initiated at our institution allows radiologists to actively and directly participate in the team-based medical model. A retrospective review of survey data evaluated the qualitative and quantitative effects of CIR on clinical management, communication, and education of referring providers and radiology residents...
April 6, 2017: Academic Radiology
https://www.readbyqxmd.com/read/28389136/bpci-everyone-wins-including-the-patient
#7
Paul K Edwards, Simon C Mears, C Lowry Barnes
BACKGROUND: Alternative payment models are becoming increasingly more common with the rising cost of the US health care. Bundled payment programs for elective hip and knee arthroplasty have shown promising results by improved outcomes and significant cost reduction. METHODS: All consecutive total joint arthroplasty with diagnosis-related group (DRG) 469/470 were included in this study. And 1427 episodes from 2009 to 2012 were defined as the baseline group; 461 episodes from October 2013 to September 2014 were defined as the Bundled Payments for Care Improvement (BPCI) group...
February 28, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28389134/private-bundles-the-nuances-of-contracting-and-managing-total-joint-arthroplasty-episodes
#8
Ameer M Elbuluk, Owen R O'Neill
In recent years, bundled payment reimbursement models have been used to address the unsustainable rising cost of healthcare. Centers for Medicare and Medicaid Services initiatives, such as Bundled Payment for Care Improvement Program, have already demonstrated their ability to create financial and performance accountability in the public sector. More recently, these value-based models have been introduced among private payers to increase coordination, quality, and efficiency. Bundled payment strategies provide incentives for physicians and healthcare professionals to eliminate unnecessary services and reduce costs...
February 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28375499/episode-based-payment-and-direct-employer-purchasing-of-healthcare-services-recent-bundled-payment-innovations-and-the-geisinger-health-system-experience
#9
Jonathan R Slotkin, Olivia A Ross, Eric D Newman, Janet L Comrey, Victoria Watson, Rachel V Lee, Megan M Brosious, Gloria Gerrity, Scott M Davis, Jacquelyn Paul, E Lynn Miller, David T Feinberg, Steven A Toms
One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms...
April 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28369885/medicare-s-acute-care-episode-demonstration-effects-of-bundled-payments-on-costs-and-quality-of-surgical-care
#10
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/28366309/hip-arthroplasty-for-fracture-vs-elective-care-one-bundle-does-not-fit-all
#11
Richard S Yoon, Siddharth A Mahure, Lorraine H Hutzler, Richard Iorio, Joseph A Bosco
BACKGROUND: To quantify how baseline differences in patients undergoing hip arthroplasty for fracture vs elective care potentially lead to significant differences in immediate health care outcomes and whether these differences affect feasibility of current bundled payment models. METHODS: New York Statewide Planning and Research Cooperative System database for the years 2000-2014. RESULTS: A total of 76,654 patients underwent total hip arthroplasty or hemiarthroplasty between 2010 and 2014; 82...
March 2, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28365040/future-considerations-for-clinical-dermatology-in-the-setting-of-21st-century-american-policy-reform-the-medicare-access-and-children-s-health-insurance-program-reauthorization-act-and-alternative-payment-models-in-dermatology
#12
John S Barbieri, Jeffrey J Miller, Harrison P Nguyen, Howard P Forman, Jean L Bolognia, Marta J VanBeek
With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall...
March 30, 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/28364146/bundled-payments-in-total-joint-arthroplasty-and-spine-surgery
#13
REVIEW
Rashad Sullivan, Landry D Jarvis, Tadhg O'Gara, Maxwell Langfitt, Cynthia Emory
PURPOSE OF REVIEW: The goal of this manuscript is to provide an overview and analysis of bundled payment models for joint replacement and select spine procedures. Advantages and disadvantages of bundled payment models will be discussed. RECENT FINDINGS: In select populations, bundled payment models have been shown to reduce costs while maintaining satisfactory outcomes. These models have not been tested with complex patient cohorts, such as older adults with fragility hip fractures, and limited data exist with bundled payment analysis in spine procedures...
March 31, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28341280/cost-effectiveness-of-staphylococcus-aureus-decolonization-strategies-in-high-risk-total-joint-arthroplasty-patients
#14
Devin M Williams, Andy O Miller, Michael W Henry, Geoffrey H Westrich, Hassan M K Ghomrawi
BACKGROUND: The risk of prosthetic joint infection increases with Staphylococcus aureus colonization. The cost-effectiveness of decolonization is controversial. We evaluated cost-effectiveness decolonization protocols in high-risk arthroplasty patients. METHODS: An analytical model evaluated risk under 3 protocols: 4 swabs, 2 swabs, and nasal swab alone. These were compared to no-screening and universal decolonization strategies. Cost-effectiveness was evaluated from the hospital, patient, and societal perspective...
February 7, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28337732/medicare-reimbursement-and-orthopedic-surgery-past-present-and-future
#15
REVIEW
R Carter Clement, Suneel B Bhat, Meredith E Clement, James C Krieg
PURPOSE OF REVIEW: This paper reviews the history and structure of Medicare reimbursement with a focus on aspects relevant to the field of orthopedic surgery. Namely, this includes Parts A and B, with particular attention paid to the origins of Diagnosis Related Groups (DRG) and the physician fee schedule, respectively. We then review newer policies affecting orthopedic surgeons. RECENT FINDINGS: Recent Medicare reforms relevant to our field include readmission penalties, the evolution of bundled payments including the mandatory Comprehensive Care for Joint Replacement (CJR) and Surgical Hip and Femur Fracture Treatment (SHFFT) programs, and the new mandatory Merit-based Incentive Payment System (MIPS) pay-for-performance program...
March 23, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28333786/the-bundled-care-disruption
#16
Carol Anne Boston-Fleischhauer
The new administration and Congress will wrestle with the Affordable Care Act and options. In the meantime, several reimbursement programs designed to disrupt current approaches to patient care delivery continue, including the Centers for Medicare & Medicaid Services bundled payment program. Chief nurse executives must prepare to advance processes and care models that align with bundled payments and the broader ambition to eliminate care variation.
April 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/28329352/costs-and-consequences-of-early-hospital-discharge-after-major-inpatient-surgery-in-older-adults
#17
Scott E Regenbogen, Anne H Cain-Nielsen, Edward C Norton, Lena M Chen, John D Birkmeyer, Jonathan S Skinner
Importance: As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective: To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions...
March 22, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28323670/prevention-of-respiratory-complications-of-the-surgical-patient-actionable-plan-for-continued-process-improvement
#18
Katarina J Ruscic, Stephanie D Grabitz, Maíra I Rudolph, Matthias Eikermann
PURPOSE OF REVIEW: Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. RECENT FINDINGS: Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders...
March 23, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28319968/four-strategies-for-succeeding-with-bundled-payments
#19
James J Pizzo, Debra L Ryan
No abstract text is available yet for this article.
September 2016: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28318861/medical-comorbidities-impact-the-episode-of-care-reimbursements-of-total-hip-arthroplasty
#20
Samuel Rosas, Karim G Sabeh, Leonard T Buller, Tsun Yee Law, Martin W Roche, Victor H Hernandez
BACKGROUND: Total hip arthroplasty (THA) costs are a source of great interest in the currently evolving health care market. The initiation of a bundled payment system has led to further research into costs drivers of this commonly performed procedure. One aspect that has not been well studied is the effect of comorbidities on the reimbursements of THA. The purpose of this study was to determine if common medical comorbidities affect these reimbursements. METHODS: A retrospective, level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary THA between 2007 and 2015...
February 24, 2017: Journal of Arthroplasty
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