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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
#1
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/27917479/hospital-postacute-care-referral-networks-is-referral-concentration-associated-with-medicare-style-bundled-payments
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/27845149/regionalization-of-cystectomy-importance-of-care-coordination-bundled-payments-and-surgical-ownership
#10
EDITORIAL
Andrew T Lenis, Karim Chamie
No abstract text is available yet for this article.
November 11, 2016: Journal of Urology
https://www.readbyqxmd.com/read/27826595/direct-cost-analysis-of-outpatient-arthroscopic-rotator-cuff-repair-in-medicare-and-non-medicare-populations
#11
Steven J Narvy, Tracey C Didinger, David Lehoang, C Thomas Vangsness, James E Tibone, George F Rick Hatch, Reza Omid, Felipe Osorno, Seth C Gamradt
BACKGROUND: Providing high-quality care while also containing cost is a paramount goal in orthopaedic surgery. Increasingly, insurance providers in the United States, including government payers, are requiring financial and performance accountability for episodes of care, including a push toward bundled payments. HYPOTHESIS: The direct cost of outpatient arthroscopic rotator cuff repair was assessed to determine whether, due to an older population, rotator cuff surgery was more costly in Medicare-insured patients than in patients covered by other insurers...
October 2016: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/27824404/contracting-strategies-for-arthroplasty-bundles-to-population-health
#12
David J Jacofsky, Paul Jawin, Geoff Walton, Lisa Fraser
Orthopedics, and especially total joint replacement (TJR), is growing in payer prominence due to large projected increases in volume. The unsustainability of the fee-for-service payment system has lead Centers for Medicare and Medicaid Services to employ new value and risk-based contracting strategies on a population health basis and on an episode of care basis, with programs such as the Bundled Payment for Care Improvement program and the Comprehensive Care for Joint Replacement program. These trends are forcing hospitals and physicians to align to improve quality and reduce costs through new structures such as Accountable Care Organizations, comanagement programs, and gainsharing...
November 4, 2016: Journal of Knee Surgery
https://www.readbyqxmd.com/read/27821421/post-acute-care-takes-center-stage-in-cms-centers-for-medicare-and-medicaid-services-plan-to-expand-use-of-bundled-payments-for-heart-attack
#13
Bridget M Kuehn
No abstract text is available yet for this article.
November 8, 2016: Circulation
https://www.readbyqxmd.com/read/27815745/a-new-perspective-on-the-value-of-minimally-invasive-colorectal-surgery-payer-provider-and-patient-benefits
#14
Deborah S Keller, Anthony J Senagore, Kathryn Fitch, Andrew Bochner, Eric M Haas
BACKGROUND: The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer's perspective to demonstrate the value of minimally invasive colorectal surgery. METHODS: A Truven MarketScan(Ā®) claim-based analysis identified all 2013 elective, inpatient colectomies. Cases were stratified into open or MIS approaches based on ICD-9 procedure codes; then costs were assessed using a similar distribution across diagnosis related groups (DRGs)...
November 4, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27815110/hospital-to-post-acute-care-facility-transfers-identifying-targets-for-information-exchange-quality-improvement
#15
Christine D Jones, Ethan Cumbler, Benjamin Honigman, Robert E Burke, Rebecca S Boxer, Cari Levy, Eric A Coleman, Heidi L Wald
INTRODUCTION: Information exchange is critical to high-quality care transitions from hospitals to post-acute care (PAC) facilities. We conducted a survey to evaluate the completeness and timeliness of information transfer and communication between a tertiary-care academic hospital and its related PAC facilities. METHODS: This was a cross-sectional Web-based 36-question survey of 110 PAC clinicians and staff representing 31 PAC facilities conducted between October and DecemberĀ 2013...
November 1, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27783000/the-influence-of-insurance-type-on-management-of-carpal-tunnel-syndrome-an-analysis-of-nationwide-practice-trends
#16
Erika D Sears, Peter R Swiatek, Hechuan Hou, Kevin C Chung
BACKGROUND: The purpose of this study was to evaluate the impact of insurance type on use of diagnostic testing, treatments, and the efficiency of care for patients with carpal tunnel syndrome. METHODS: The 2009 to 2013 Truven MarketScan Databases were used to identify adult patients with carpal tunnel syndrome. Insurance type was categorized as fee-for-service versus capitated managed care. Multivariable regression models were created to evaluate the relationship between insurance type and costs, number of visits, treatment, and electrodiagnostic study use, and controlling for demographic characteristics and comorbidities...
November 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27776899/the-association-between-hospital-length-of-stay-and-90-day-readmission-risk-within-a-total-joint-arthroplasty-bundled-payment-initiative
#17
Jarrett Williams, Benjamin S Kester, Joseph A Bosco, James D Slover, Richard Iorio, Ran Schwarzkopf
BACKGROUND: To curb the unsustainable rise in health care expenses, health care payers are developing programs to incentivize hospitals and physicians to improve the value of care delivered to patients. Payers are utilizing various metrics, such as length of stay (LOS) and unplanned readmissions, to track progression of quality metrics. Relevant to orthopedic surgeons, the Centers for Medicare and Medicaid Services announced in 2015 the Comprehensive Care for Joint Replacement Payment Model-a program aimed at improving the quality of health care delivered to patients by shifting more of the financial risk of patient care onto providers...
September 28, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27768180/association-of-a-bundled-payment-program-with-cost-and-outcomes-in-full-cycle-breast-cancer-care
#18
C Jason Wang, Skye H Cheng, Jen-You Wu, Yi-Ping Lin, Wen-Hsin Kao, Chia-Li Lin, Yin-Jou Chen, Shu-Ling Tsai, Feng-Yu Kao, Andrew T Huang
Importance: Value-driven payment system reform is a potential tool for aligning economic incentives with the improvement of quality and efficiency of health care and containment of cost. Such a payment system has not been researched satisfactorily in full-cycle cancer care. Objective: To examine the association of outcomes and medical expenditures with a bundled-payment pay-for-performance program for breast cancer in Taiwan compared with a fee-for-service (FFS) program...
October 20, 2016: JAMA Oncology
https://www.readbyqxmd.com/read/27755264/understanding-value-based-reimbursement-models-and-trends-in-orthopaedic-health-policy-an-introduction-to-the-medicare-access-and-chip-reauthorization-act-macra-of-2015
#19
Khaled J Saleh, William O Shaffer
In 2015, the US Congress passed legislation entitled the Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization Act (MACRA), which led to the formation of two reimbursement paradigms: the merit-based incentive payment system (MIPS) and alternative payment models (APMs). The MACRA effectively repealed the Centers for Medicare and Medicaid Services (CMS) sustainable growth rate (SGR) formula while combining several CMS quality-reporting programs. As such, MACRA represents an unparalleled acceleration toward reimbursement models that recognize value rather than volume...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27729444/can-payment-reform-be-social-reform-the-lure-and-liabilities-of-the-triple-aim
#20
Sandra J Tanenbaum
The formulation of the triple aim responds to three problems facing the US health care system: high cost, low quality, and poor health status. The purpose of this article is to analyze the potential of the health care system to achieve the triple aim and, specifically, the attempt to improve population health by rewarding providers who contain costs. The first section of the article will consider the task of improving population health through the health care system. The second section of the article will discuss CMS's efforts to pay providers to achieve the triple aim, that is, to improve health care and population health while containing cost...
October 11, 2016: Journal of Health Politics, Policy and Law
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