Physician Reimbursement: Fee-for-Service, Accountable Care, and the Future of Bundled Payments.

Published on May 1, 2020in Hand Clinics1.907
· DOI :10.1016/J.HCL.2019.12.002
Miller-Breslow A2
Estimated H-index: 2
,
Noah M. Raizman1
Estimated H-index: 1
Sources
Abstract
In 1992, the use of relative value units to link a particular payments with specific services was initiated to replace traditional fee for service. The system incentivizes volume rather than quality. In 1997, initiatives were formalized to emphasize quality measures. Physicians must participate in the Merit-based Incentive Payment System (MIPS). Physicians can opt out of MIPS if they participate in an Alternative Payment Model such as Bundled Payments. Reimbursement based on an episode of care reduces perceived incentive to increase volumes, but may result in difficulty with access to care for patients with complex medical issues or significant comorbidities.
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#2Zain Sayeed (DMC: Detroit Medical Center)H-Index: 10
Last. Khaled J. Saleh (DMC: Detroit Medical Center)H-Index: 49
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Abstract Background Alternative payment models for total hip arthroplasty (THA) were initiated by the Center for Medicare and Medicaid Services to decrease overall healthcare cost. The associated shift of financial risk to participating institutions may negatively influence patient selection to avoid high cost of care (“cherry picking,” “lemon dropping”). This study evaluated the impact of the Comprehensive Care for Joint Replacement (CJR) model on patient selection, care delivery, and hospital ...
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Importance In 2016, the Centers for Medicare & Medicaid Services (CMS) launched its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, by randomizing metropolitan statistical areas (MSAs) into the payment model. Objective To evaluate changes in key economic and clinical outcomes associated with the CJR model. Design, Setting, and Participants A retrospective, national, population-based analysis of Medicare fee-for-service beneficiaries undergoing l...
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#2Daniel E. Goltz (Duke University)H-Index: 8
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Abstract Background The Center for Medicare and Medicaid Services has instituted bundled reimbursement models for total joint arthroplasty (TJA), which includes target prices for each procedure. Some patients exceed these targets; however, currently there are no tools to accurately predict this preoperatively. We hypothesized that a validated comorbidity index combined with patient demographics would adequately predict excess cost-of-care prior to hospitalization. Methods Two thousand eighty-fou...
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#2David Novikov (NYU: New York University)H-Index: 5
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Abstract Background The Bundled Payment Care Improvement (BPCI) initiative aims to improve quality of patient care while mitigating cost. How patient age and frailty affect reimbursement after hip and knee total joint arthroplasty (TJA) is not known. This study evaluates if patient age and frailty affect cost of care. Methods A retrospective review of prospectively collected data of 1821 patients undergoing TJA at our institution under the BPCI initiative was performed from 2013 to 2016. We reco...
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Purpose Distal radius fracture open reduction and internal fixation (ORIF) represents a considerable cost burden to the health care system. We aimed to elucidate demographic-, injury-, and treatment-specific factors influencing surgical encounter costs for distal radius ORIF. Methods We retrospectively reviewed adult patients treated with isolated distal radius ORIF between November 2014 and October 2016 at a single tertiary academic medical center. Using our institution's information technology...
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Importance Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. Objective To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Swe...
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Practicing orthopaedic surgeons are subject to both the requirement and the opportunity to participate in individual or group quality assessment, quality-based payment programs, and clinical data registries. An important limitation to participating in and receiving the benefits of quality measuring activities and programs is the lack of a current resource outlining quality assessment models, current quality metrics, and the presence and function of current quality programs, payment models, and a...
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