Bundled payment

Last updated

Bundled payment is the reimbursement of health care providers (such as hospitals and physicians) "on the basis of expected costs for clinically-defined episodes of care." [1] [2] [3] [4] [5] It has been described as "a middle ground" between fee-for-service reimbursement (in which providers are paid for each service rendered to a patient) and capitation (in which providers are paid a "lump sum" per patient regardless of how many services the patient receives), given that risk is shared between payer and provider. [6] Bundled payments have been proposed in the health care reform debate in the United States as a strategy for reducing health care costs, especially during the Obama administration (2009–2016). [7] Commercial payers have shown interest in bundled payments in order to reduce costs. [8] In 2012, it was estimated that approximately one-third of the United States healthcare reimbursement used bundled methodology. [9]

Contents

Terminology

Also known as episode-based payment, episode payment, episode-of-care payment, case rate, evidence-based case rate, global bundled payment, global payment, package pricing, or packaged pricing.

History

In the mid-1980s, it was believed that Medicare's hospital prospective payment system with diagnosis-related groups may have led to hospitals' discharging patients to post-hospital care (such as skilled nursing facilities) more quickly than was appropriate, to save money. [10] It was therefore suggested that Medicare bundle payments for hospital and posthospital care; [10] however, despite favorable analyses of the idea, [11] [12] it had not been implemented, as of 2009. [13]

Bundled payments began as early as 1984, when The Texas Heart Institute, under the direction of Denton Cooley, began to charge flat fees for both hospital and physician services for cardiovascular surgeries. [5] [14] Authors from the Institute claimed that its approach "maintain[ed] a high quality of care" while lowering costs (in 1985, the flat fee for coronary artery bypass surgery at the institute was $13,800 as opposed to the average Medicare payment of $24,588). [14]

Another early experience with bundled payments occurred between 1987 and 1989, involving an orthopedic surgeon, a hospital (Ingham Regional Medical Center), and a health maintenance organization (HMO) in Michigan. [5] [15] The HMO referred 111 patients to the surgeon for possible surgery; the surgeon would evaluate each patient for free. [15] The surgeon and the hospital received a predetermined fee for any arthroscopic surgery performed, but they also provided a two-year warranty in that they promised to cover any post-surgery expenses (for example, four re-operations) instead of the HMO. [15] Under this arrangement, "all parties benefitted financially": the HMO paid $193,000 instead of the $318,538 expected; the hospital received $96,500 instead of the $84,892 expected; and the surgeon and his associates received $96,500 instead of the $51,877 expected. [15]

In 1991, a "Medicare Participating Heart Bypass Center Demonstration" began in four hospitals across the United States; three other hospitals were added to the project in 1993, and the project concluded in 1996. [1] [16] In the demonstration, Medicare paid global inpatient hospital and physician rates for hospitalizations for coronary artery bypass surgery; the rates included any related readmissions. [1] Among the published evaluations of the project were the following:

By 2001, "case rates for episodes of illness" (bundled payments) were recognized as one type of "blended payment method" (combining retrospective and prospective payment) along with "capitation with fee-for-service carve-outs" and "specialty budgets with fee-for-service or 'contact' capitation." [18] In subsequent years, other blended methods of payment have been proposed such as "comprehensive care payment", [5] "comprehensive payment for comprehensive care", [19] and "complete chronic care" [20] which incorporate payment for keeping people as healthy as possible in addition to payment for episodes of illness.

The St. Joseph Hospital in Denver held an acute-care episode (ACE) demonstration project in 2003, administered by Deirdre Baggot. Based on the Medicare Prescription Drug Improvement and Modernization Act, the ACE demonstration bundled Parts A and B of Medicare for episodes of care. [21]

In 2006–2007, the Geisinger Health System tested a "ProvenCare" model for coronary artery bypass surgery that included best practices, patient engagement, and "preoperative, inpatient, and postoperative care [rehospitalizations] within 90 days... packaged into a fixed price." [22] The program received national attention including articles in The New York Times [23] and the New England Journal of Medicine [24] in mid-2007. An evaluation published in late 2007 showed that 117 patients who received "ProvenCare" had a significantly shorter total length of stay (resulting in 5% lower hospital charges), a greater likelihood of being discharged to home, and a lower readmission rate compared with 137 patients who received conventional care in 2005. [22]

The Robert Wood Johnson Foundation gave grants beginning in 2007 for a bundled payment project called PROMETHEUS ("Provider payment Reform for Outcomes, Margins, Evidence, Transparency, Hassle-reduction, Excellence, Understandability and Sustainability") Payment. [25] With support of the Commonwealth Fund, the project developed "evidence-informed case rates" for various conditions that are adjusted for severity and complexity of a patient's illness. [26] [27] [28] The "evidence-informed case rates" are used to set budgets for episodes of care. [27] If actual quarterly spending by health care providers is under budget, the providers receive a bonus; if actual quarterly spending is over budget, payment to the providers is partially withheld. [27] The model is currently being tested in three pilot sites which are scheduled to end in 2011. [27] [28]

In mid-2008, the Medicare Payment Advisory Commission made several recommendations along "a path to bundled payment." [29] [30] For one, it recommended that the Secretary of Health and Human Services examine approaches such as "virtual bundling" (under which providers would receive separate payments, but could also be subject to rewards or penalties based on the levels of expenditures). [29] In addition, it recommended that a pilot program be established "to test the feasibility of actual bundled payment for services around hospitalization episodes for select conditions." [29]

Just before the Medicare Payment Advisory Commission report was released, the Centers for Medicare and Medicaid Services announced a "Medicare Acute Care Episode (ACE) Demonstration" project for bundling payments for certain cardiovascular and orthopedic procedures. [31] The bundling includes only hospital and physician charges, not post-discharge care; by 2009, five sites in Colorado, New Mexico, Oklahoma, and Texas had been selected for the project. [32] In the project, hospitals give Medicare discounts of 1%-6% for the selected procedures, and Medicare beneficiaries receive a $250–$1,157 incentive to receive their procedures in the demonstration hospitals. [33]

Bundled payments for Medicare were a major feature of a November 2008 white paper by Senator Max Baucus, chair of the Senate Finance Committee. [34] The white paper recommended that the Medicare ACE Demonstration "expand to other sites," "focus on other clinical conditions if certain criteria are met," and "include services that are provided post-hospitalization." [35]

As of 2008, Geisinger's ProvenCare program had "attracted interest from Medicare officials and other top industry players" [2] and had been expanded or was in the process of being expanded to hip replacement surgery, cataract surgery, percutaneous coronary intervention, bariatric surgery, lower back surgery, and perinatal care. [36] Interest in Geisinger's experience intensified in 2009 when newsmedia reports claimed that it was a model for health care reforms to be proposed by President Barack Obama [37] and when Obama himself mentioned Geisinger in two speeches. [7] [38]

In July 2009, a Special Commission on the Health Care Payment System in Massachusetts distinguished between episode-based payments (i.e., bundled payments) and "global payments" that were defined as "fixed-dollar payments for the care that patients may receive in a given time period... plac[ing] providers at financial risk for both the occurrence of medical conditions and the management of those conditions." [3] The Commission recommended that global payments "with adjustments to reward provision of accessible and high quality care" (not bundled payments) be used for Massachusetts health care providers. [39] Among the reasons for selecting global payment were its potential to reduce episodes of care and previous experience with this payment method in Massachusetts. [39]

As of 2010, provisions for bundled payments are included in both the Patient Protection and Affordable Care Act and the Affordable Health Care for America Act. [40] The former bill establishes a national Medicare pilot program starting in 2013 with possible expansion in 2016, [41] which is consistent with the Obama proposal. [40] The latter bill requires "a plan to reform Medicare payments for post-acute services, including bundled payments." [40] 450 healthcare organizations participated in the Bundled Payments for Care Improvement (BPCI) initiative held by the Centers for Medicare & Medicaid Services. The program tested the ability of bundling payments for services as a method for improving quality and lowering costs. [21] In June 2016, CMS announced it would be extending the program for two more years. [42]

In July 2015, Centers for Medicare & Medicaid Services announced its proposal to mandate a 90-day bundled payment model as a new program for Medicare beneficiaries undergoing joint replacement called the Comprehensive Care for Joint Replacement initiative. The initiative is based on the Bundled Payments for Care Improvement program launched in 2011 and research from the Acute Care Episode demonstration project. The new program will improve cost efficiencies, patient outcomes, and collaboration among providers for an episode of care. Bundled payments will eliminate the demand for unnecessary testing and treatments. [43] In July 2016, CMS announced three new bundles, referred to as episode payment models (EPMs) aimed at cardiovascular care procedures including acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and hip/ femur fractures. The new model will go into effect on July 1, 2017. [44]

In January 2018, The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) introduced the successor to the BPCI program, BPCI Advanced, which is a voluntary episode payment model that will start on October 1, 2018, and run through December 31, 2023.

According to CMS' FAQ [45] on the program, "There are two categories of Participants under BPCI Advanced: [46] Convener Participants and Non-Convener Participants. A Convener Participant is a type of Participant that brings together multiple downstream entities referred to as "Episode Initiators"—which must be either Acute Care Hospitals (ACHs) or Physician Group Practices (PGPs)—to participate in BPCI Advanced, facilitates coordination among them, and bears and apportions financial risks."

Advantages

Advocates of bundled payments note:

Considerations

Before practices choose to participate in bundled payments, they need to be diligent in researching potential episodes of care that would be amenable to this type of reimbursement. Traditionally, physician's quality monitoring and improvement is managed by the hospital's nursing sector. Transitioning to a bundled payment methodology shifts accountability back to physicians, thus considerations for their delivery in an acute care episode is essential as well as realigning strategic nursing priorities to enable the needed capacity for care delivery transformation. [8] Once they have selected and defined an episode of care, they should:

According to a February 2018 Health Affairs article, Government As Innovation Catalyst: Lessons From The Early Center For Medicare And Medicaid Innovation Models, [54] "The [BPCI] initiative also highlighted business and operational barriers to implementing this approach. These included managing cash flows, developing budgets for episodes paid prospectively (rather than retrospectively), and reliably tracking providers' enrollment in a bundled payment model. Convening organizations (such as Premier or Remedy Partners, which brought multiple providers together to support implementation and sometimes shouldered some financial risk), could bring bundles to scale faster but introduced the additional complexity of a three-way arrangement among payer, convener, and provider."

In Case study: Delivery and payment reform in congestive heart failure at two large academic centers, [55] published in the July 2014 edition of Healthcare: The Journal of Delivery Science and Innovation, the authors state, "Convening organizations play a key role in providing technical assistance and implementation support. Clinical leaders and health systems do not always have a complete set of tools for payment reform. Thus, conveners contracted by CMMI, played a helpful role in catalyzing payment reform for their members."

Design options

Implementation of bundled payments can take many different forms. Several of the key design dimensions include:

Disadvantages

The drawbacks of a bundled payment approach include:

Related Research Articles

<span class="mw-page-title-main">Medicaid</span> United States social health care program for families and individuals with limited resources

In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.

<span class="mw-page-title-main">Medicare (United States)</span> US government health insurance program

Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis. It was begun in 1965 under the Social Security Administration (SSA) and is now administered by the Centers for Medicare and Medicaid Services (CMS).

Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group being "Ungroupable". This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health. The system is also referred to as "the DRGs", and its intent was to identify the "products" that a hospital provides. One example of a "product" is an appendectomy. The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace "cost based" reimbursement that had been used up to that point. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.

<span class="mw-page-title-main">Mark McClellan</span> American health economist (born 1963)

Mark Barr McClellan is the director of the Robert J Margolis Center for Health Policy and the Margolis Professor of Business, Medicine and Health Policy at Duke University. Formerly, he was a senior fellow and director of the Health Care Innovation and Value Initiative at the Engelberg Center for Health Care Reform at The Brookings Institution, in Washington, D.C. McClellan served as commissioner of the United States Food and Drug Administration under President George W. Bush from 2002 through 2004, and subsequently as administrator of the Centers for Medicare and Medicaid Services from 2004 through 2006.

Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician has a financial relationship with that entity.

Dual-eligible beneficiaries refers to those qualifying for both Medicare and Medicaid benefits. In the United States, approximately 9.2 million people are eligible for "dual" status. Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries.

In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.

Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately.

Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.

<span class="mw-page-title-main">Rural health clinic</span>

A rural health clinic (RHC) is a clinic located in a rural, medically under-served area in the United States that has a separate reimbursement structure from the standard medical office under the Medicare and Medicaid programs. RHCs were established by the Rural Health Clinic Services Act of 1977, . The RHC program increases access to health care in rural areas by

  1. creating special reimbursement mechanisms that allow clinicians to practice in rural, under-served areas
  2. increasing utilization of physician assistants (PA) and nurse practitioners (NP)

Cost-shifting is an economic situation where one individual, group, or government underpays for a service, resulting in another individual, group, or government overpaying for a service. It can occur when one group pays a smaller share of costs than before, resulting in another group paying a larger share of costs than before. Some commentators on health policy in the United States believe the former currently happens in Medicare and Medicaid as they underpay for services resulting in private insurers overpaying. Although the term cost shift is used in the field of healthcare these days and there are many studies about it, other fields have more or less used it. For example, its origins go back to the environmental economy where cost-shifting referred to the practice where corporations pass the harmful consequences and negative externalities of economic production to third parties and communities whether those that are part of the production circuit or are in some way beneficiaries or those that are outside this circle, K.W. Kapp, is one who coined the concept. This concept is also used in the American legal system, especially since the cost of electronic discovery has increased dramatically due to a large amount of raw information and the urgent need to extract relevant data, its processing, and analysis. In the past, each of the plaintiffs and defendants had to bear the cost, but later many of those who prepared the summons demanded the transfer of the cost because they thought they would have to pay for something they did not do. In this regard, some courts have agreed to shift part of the costs to the complainant.

There were a number of different health care reforms proposed during the Obama administration. Key reforms address cost and coverage and include obesity, prevention and treatment of chronic conditions, defensive medicine or tort reform, incentives that reward more care instead of better care, redundant payment systems, tax policy, rationing, a shortage of doctors and nurses, intervention vs. hospice, fraud, and use of imaging technology, among others.

An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".

Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. It is a pervasive problem in the United States with providers who are out of network, and therefore not subject to the rates or terms of providers who are in-network. Balance billing has a variable prevalence by market and specialty.

The Medicare Physician Group Practice (PGP) demonstration was Medicare's first physician pay-for-performance (P4P) initiative. The demonstration established incentives for quality improvement and cost efficiency. Ten large physician groups participated in the demonstration, which started on April 1, 2005, and ran for 5 years. Previous funding arrangements, like the volume performance standard (VPS) and the sustainable growth rate (SGR) did not provide incentives to slow the growth of services. The Medicare PGP demonstration was intended to overcome that limitation in previous funding arrangements.

Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.

A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems. Generally, higher readmission rate indicates ineffectiveness of treatment during past hospitalizations. Hospital readmission rates were formally included in reimbursement decisions for the Centers for Medicare and Medicaid Services (CMS) as part of the Patient Protection and Affordable Care Act (ACA) of 2010, which penalizes health systems with higher than expected readmission rates through the Hospital Readmission Reduction Program. Since the inception of this penalty, there have been other programs that have been introduced, with the aim to decrease hospital readmission. The Community Based Care Transition Program, Independence At Home Demonstration Program, and Bundled Payments for Care Improvement Initiative are all examples of these programs. While many time frames have been used historically, the most common time frame is within 30 days of discharge, and this is what CMS uses.

The Oncology Care Model (OCM) is an episode-based payment system developed by the Center for Medicare and Medicaid Innovation. The multipayer model is designed for discrete instances of care, especially those involving chemotherapy, which triggers the six-month episode. The program combines fee-for-service (FFS) payments for established services, monthly payments for additional care under a structured guideline, and performance-based payments weighed against quality metrics and benchmarks.

Health care efficiency is a comparison of delivery system outputs, such as physician visits, relative value units, or health outcomes, with inputs like cost, time, or material. Efficiency can be reported then as a ratio of outputs to inputs or a comparison to optimal productivity using stochastic frontier analysis or data envelopment analysis. An alternative approach is to look at latency times and delay times between a care order and completion of work, and stated accomplishment in relation to estimated effort.

How healthcare payment is managed is one of key policies that countries have to drive healthcare system. Payment for healthcare is managed in various ways. The main categories of payment systems are salary, capitation, bundled payment, global budget and fee-for-service. Most countries have mixed systems of physician payment.

References

  1. 1 2 3 4 5 Cromwell J, Dayhoff DA, Thoumaian AH (1997). "Cost savings and physician responses to global bundled payments for Medicare heart bypass surgery". Health Care Financ Rev. 19 (1): 41–57. PMC   4194487 . PMID   10180001.
  2. 1 2 Miller J (1 June 2008). "Package pricing: Geisinger's new model holds the promise of aligning payment with optimal care". Managed Healthcare Executive. Archived from the original on 2010-10-01. Retrieved 2010-03-11.
  3. 1 2 3 4 Commonwealth of Massachusetts, Special Commission on the Health Care Payment System (16 July 2009). "Recommendations of the Special Commission on the Health Care Payment System. Appendix C: memos on basic payment models and complementary payment-related strategies" (PDF). Archived from the original (PDF) on 2011-06-04. Retrieved 2010-03-11.
  4. 1 2 3 4 Satin DJ, Miles J (2009). "Performance-based bundled payments: potential benefits and burdens" (PDF). Minn Med. 92 (10): 33–5. PMID   19916270. Archived from the original (PDF) on 2017-02-02. Retrieved 2016-09-09.
  5. 1 2 3 4 5 6 7 8 Miller HD (2009). "From volume to value: better ways to pay for health care". Health Aff (Millwood). 28 (5): 1418–28. doi:10.1377/hlthaff.28.5.1418. PMID   19738259. Archived from the original on 2013-04-15.
  6. ↑ RAND Corporation. "Overview of bundled payment" . Retrieved 2010-03-11.
  7. 1 2 Obama B (15 June 2009). "Remarks by the President at the annual conference of the American Medical Association". whitehouse.gov . Retrieved 2010-03-11– via National Archives.
  8. 1 2 3 Deirdre Baggot (September 2010). "Bundled Payments: Ten Critical Success Factors". GE Healthcare Camden Group. Archived from the original on June 17, 2016. Retrieved June 13, 2016.
  9. 1 2 Deirdre Baggot (July 2012). "Top 10 Considerations for Clinical Service Line Leaders". GE Healthcare Camden Group. Archived from the original on June 17, 2016. Retrieved June 13, 2016.
  10. 1 2 Neu CR, Palmer A, Henry DP, Olson GT, Harrison S (May 1986). "Extending the Medicare prospective payment system to posthospital care. Planning a demonstration" (PDF). Santa Monica, CA: RAND Corporation. Retrieved 2010-03-11.
  11. ↑ Welch WP (1998). "Bundled Medicare payment for acute and postacute care" (PDF). Health Aff (Millwood). 17 (6): 69–81. doi:10.1377/hlthaff.17.6.69. PMID   9916356.[ permanent dead link ]
  12. ↑ Congressional Budget Office (December 2008). "Chapter 5. The quality and efficiency of health care. Option 30. Bundle payments for hospital care and post-acute care" (PDF). Budget options. Volume I. Health care. Washington, DC: Congress of the United States. pp. 62–63. Archived from the original (PDF) on 2012-02-17. Retrieved 2010-03-11.
  13. ↑ Center for Post-acute Studies (2009). "Bundling payment for post-acute care: building blocks and policy options" (PDF). Washington, DC: National Rehabilitation Hospital. Archived from the original (PDF) on 2011-07-27. Retrieved 2010-03-11.
  14. 1 2 Edmonds C, Hallman GL (1995). "CardioVascular Care Providers. A pioneer in bundled services, shared risk, and single payment". Tex Heart Inst J. 22 (1): 72–6. PMC   325213 . PMID   7787473.
  15. 1 2 3 4 Johnson LL, Becker RL (1994). "An alternative health-care reimbursement system -- application of arthroscopy and financial warranty: results of a 2-year pilot study". Arthroscopy. 10 (4): 462–70, discussion 471–2. doi:10.1016/S0749-8063(05)80200-2. PMID   7945644.
  16. 1 2 3 4 Cromwell J, Dayhoff DA, McCall NT, Subramanian S, Freitas RC, Hart RJ, Caswell C, Stason W (1998-07-24). "Medicare Participating Heart Bypass Demonstration. Executive summary. Final report" (PDF). Waltham, MA: Health Economics Research, Inc. Archived from the original (PDF) on 2009-11-22. Retrieved 2010-03-11.
  17. ↑ Liu CF, Subramanian S, Cromwell J (2001). "Impact of global bundled payments on hospital costs of coronary artery bypass grafting". J Health Care Finance. 27 (4): 39–54. PMID   11434712.
  18. ↑ Robinson JC (2001). "Theory and practice in the design of physician payment incentives". Milbank Q. 79 (2): 149–77. doi:10.1111/1468-0009.00202. PMC   2751195 . PMID   11439463.
  19. ↑ Goroll AH, Berenson RA, Schoenbaum SC, Gardner LB (2007). "Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care". J Gen Intern Med. 22 (3): 410–5. doi:10.1007/s11606-006-0083-2. PMC   1824766 . PMID   17356977.
  20. ↑ Health CEOs for Health Reform (12 June 2009). "Realigning U.S. health care incentives to better serve patients and taxpayers" (PDF). Washington, DC: New America Foundation. Archived from the original (PDF) on 28 April 2011. Retrieved 2010-03-13.
  21. 1 2 Jessica Zigmond (January 31, 2013). "More than 450 provider organizations join payment-bundling initiative". Modern Healthcare. Retrieved June 13, 2016.
  22. 1 2 Casale AS, Paulus RA, Selna MJ, Doll MC, Bothe AE Jr, McKinley KE, Berry SA, Davis DE, Gilfillan RJ, Hamory BH, Steele GD Jr (2007). "'ProvenCareSM': a provider-driven pay-for-performance program for acute episodic cardiac surgical care" (PDF). Ann Surg. 246 (4): 613–21, discussion 621–3. doi:10.1097/SLA.0b013e318155a996. PMID   17893498. S2CID   29735383. Archived from the original (PDF) on 2010-08-27.
  23. ↑ Abelson R (17 May 2007). "In bid for better care, surgery with a warranty". The New York Times. Retrieved 2010-03-11.
  24. ↑ Lee TH (2007). "Pay for performance, version 2.0?" (PDF). N Engl J Med. 357 (6): 531–3. doi:10.1056/NEJMp078124. PMID   17687128. Archived from the original (PDF) on 2010-08-27.
  25. ↑ Gosfield AG (June 2008). "Making PROMETHEUS payment rates real: ya' gotta start somewhere" (PDF). Princeton, NJ: Robert Wood Johnson Foundation. Archived from the original (PDF) on 2011-09-27. Retrieved 2010-03-13.
  26. ↑ de Brantes F, Camillus JA (April 2007). "Evidence-informed case rates: a new health care payment model" (PDF). Washington, DC: The Commonwealth Fund. Archived from the original (PDF) on 2011-07-20. Retrieved 2010-03-13.
  27. 1 2 3 4 de Brantes F, Rosenthal MB, Painter M (2009). "Building a bridge from fragmentation to accountability--the Prometheus Payment model". N Engl J Med. 361 (11): 1033–6. doi:10.1056/NEJMp0906121. PMID   19692682.
  28. 1 2 Prometheus Payment, Inc. "Our funding". Archived from the original on 2008-08-20. Retrieved 2010-03-13.
  29. 1 2 3 4 5 Medicare Payment Advisory Commission (June 2008). "Chapter 4. A path to bundled payment around a hospitalization" (PDF). Report to the Congress: reforming the delivery system. Washington, DC: Medicare Payment Advisory Commission. pp. 80–103. Archived from the original (PDF) on 2008-09-16. Retrieved 2010-03-11.
  30. ↑ Hackbarth G, Reischauer R, Mutti A (2008). "Collective accountability for medical care--toward bundled Medicare payments" (PDF). N Engl J Med. 359 (1): 3–5. doi:10.1056/NEJMp0803749. PMID   18596270. Archived from the original (PDF) on 2011-07-26.
  31. ↑ Alexander J (2008). "Payment by episode: momentum building for bundling?". Healthc Financ Manage. 62 (7): 40–1. PMID   18683410.
  32. ↑ Centers for Medicare & Medicaid Services (11 March 2010). "Medicare demonstrations. Details for Medicare Acute Care Episode (ACE) Demonstration" . Retrieved 2010-03-13.[ permanent dead link ]
  33. 1 2 Galewitz P (26 October 2009). "Can 'bundled' payments help slash health costs?". USA Today. Retrieved 2010-03-11.
  34. ↑ Goldstein J (30 January 2009). "Medicare-payment fix weighed". Wall Street Journal. Retrieved 2010-03-11.
  35. ↑ Baucus M (12 November 2008). "Call to action. Health reform 2009" (PDF). Archived from the original (PDF) on January 5, 2010. Retrieved 2010-03-11.
  36. ↑ Paulus RA, Davis K, Steele GD (2008). "Continuous innovation in health care: implications of the Geisinger experience" (PDF). Health Aff (Millwood). 27 (5): 1235–45. doi:10.1377/hlthaff.27.5.1235. PMID   18780906. Archived from the original (PDF) on 2010-05-28. Retrieved 2010-03-16.
  37. ↑ Connolly C (31 March 2009). "For this health system, less is more. Program that guarantees doing things right the first time, for flat fee, pays off". Washington Post. Retrieved 2010-03-11.
  38. ↑ Obama B (11 June 2009). "Remarks by the President in Town Hall Meeting on Health Care in Green Bay, Wisconsin". whitehouse.gov . Retrieved 2010-03-11– via National Archives.
  39. 1 2 Commonwealth of Massachusetts, Special Commission on the Health Care Payment System (16 July 2009). "Recommendations of the Special Commission on the Health Care Payment System" (PDF). Archived from the original (PDF) on 2011-10-25. Retrieved 2010-03-11.
  40. 1 2 3 Henry J. Kaiser Family Foundation (24 February 2010). "Side-by-side comparison of major health care reform proposals" (PDF). Menlo Park, CA: Henry J. Kaiser Family Foundation. Archived from the original (PDF) on 2010-03-20. Retrieved 2010-03-13.
  41. ↑ Bundled Payments – Medicare Pilot Program. Health Reform GPS: a Joint Project of the George Washington University and the Robert Wood Johnson Foundation. http://healthreformgps.org/resources/bundled-payments-%E2%80%93-medicare-pilot-program/ Archived 2010-05-14 at the Wayback Machine .
  42. ↑ "Business Consult: CMS is Upping its Bet on Bundled Payments Deirdre Baggot, PhD, MBA, RN, Former Expert Reviewer, Bundled Payments for Care Improvement Initiative at CMS Former Lead, CMS Acute Care Episode (ACE) Demonstration Principal, ECG Management Consultants". American College of Cardiology. June 1, 2016. Retrieved August 18, 2016.
  43. ↑ Deirdre Baggot; Andy Edeburn (October 1, 2015). "Mandated Bundled Payments Compel Hospitals to Rethink Post-Acute Care". Healthcare Financial Management.
  44. ↑ Baggot, Deirdre; Manis, Tori (September 15, 2016). "CMS Targets Cardiovascular Care with New Mandatory Bundles". CardioSource World News. Retrieved October 26, 2016.
  45. ↑ "Centers for Medicare & Medicaid Services" (PDF). 2018-05-18.
  46. ↑ "BPCI Advanced | Center for Medicare & Medicaid Innovation". innovation.cms.gov. Retrieved 2018-05-24.
  47. ↑ Lisa Chow (November 27, 2013). "Hospital Puts Docs On the Spot to Lower Costs". NPR. Retrieved June 13, 2016.
  48. 1 2 3 4 Deirdre Baggot (April 2011). "Bundled Payments Revisited: 10 New Critical Success Factors". GE Healthcare Camden Group. Archived from the original on June 17, 2016. Retrieved June 13, 2016.
  49. ↑ Mechanic RE, Altman SH (2009). "Payment reform options: episode payment is a good place to start". Health Aff (Millwood). 28 (2): w262-71. doi:10.1377/hlthaff.28.2.w262. PMID   19174388.
  50. 1 2 Hussey PS, Eibner C, Ridgely MS, McGlynn EA (2009). "Controlling U.S. health care spending--separating promising from unpromising approaches". N Engl J Med. 361 (22): 2109–11. doi:10.1056/NEJMp0910315. PMID   19907037.
  51. 1 2 3 RAND COMPARE (Comprehensive Assessment of Reform Efforts). "Overview of bundled payment". RAND Corporation. Retrieved 2010-03-13.
  52. ↑ "Bundled Payments: What Physicians Need to Know" Archived 2017-09-16 at the Wayback Machine Shelly K. Schwartz, Physicians Practice, November 2012.
  53. ↑ "Taming Payment and Delivery Model Monsters" [ permanent dead link ] Sheri Porter, AAFP News, September 2012.
  54. ↑ Perla, Rocco J.; Pham, Hoangmai; Gilfillan, Richard; Berwick, Donald M.; Baron, Richard J.; Lee, Peter; McCannon, C. Joseph; Progar, Kevin; Shrank, William H. (2018-05-18). "Government As Innovation Catalyst: Lessons From The Early Center For Medicare And Medicaid Innovation Models". Health Affairs. 37 (2): 213–221. doi:10.1377/hlthaff.2017.1109. PMID   29401006.
  55. ↑ George, Meaghan; Bencic, Sara; Bleiberg, Sarah; Alawa, Nawara; Sanghavi, Darshak (2014-07-01). "Case study: Delivery and payment reform in congestive heart failure at two large academic centers". Healthcare. 2 (2): 107–112. doi: 10.1016/j.hjdsi.2014.04.001 . ISSN   2213-0764. PMID   26250378.
  56. ↑ "Bundled Payments". www.ama-assn.org. Archived from the original on 2016-10-13. Retrieved 2016-09-29.
  57. ↑ "Bundling payment for episodes of care: Balancing the financial risk of health care" (PDF). 3M Health Information Systems.
  58. ↑ Robinson JC, Williams T, Yanagihara D (2009). "Measurement of and reward for efficiency in California's pay-for-performance program. How the Integrated Healthcare Association discovered the problems of using 'episodes of care' as the basis for physician performance rewards" (PDF). Health Aff (Millwood). 28 (5): 1438–47. doi:10.1377/hlthaff.28.5.1438. PMID   19738261. S2CID   6428264.
  59. 1 2 Robinow A (February 2010). "The potential of global payment: insights from the field" (PDF). Washington, DC: The Commonwealth Fund. Archived from the original (PDF) on 2010-05-18. Retrieved 2010-03-13.
  60. 1 2 Guterman S, Davis K, Schoenbaum S, Shih A (2009). "Using Medicare payment policy to transform the health system: a framework for improving performance". Health Aff (Millwood). 28 (2): w238-50. doi:10.1377/hlthaff.28.2.w238. PMID   19174386.
  61. ↑ Deirdre Baggot (July 7, 2014). "The Bundled Payment Title Wave: Recap and Insight from the Fourth National Bundled Payment Summit". Oregon Healthcare News. Retrieved June 13, 2016.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.