Achieving cost control, care coordination, and quality improvement through incremental payment system reform

Journal of Ambulatory Care Management

Volumn 33, Issue 1, 2010, Pages 2-23

  Averill, Richard F ^a   Goldfield, Norbert I ^a   Vertrees, James C ^a   McCullough, Elizabeth C ^a   Fuller, Richard L ^a   Eisenhandler, Jon ^a  

^a 3M COMPANY   (United States)

Author keywords

Cost control; Financial incentives; Healthcare reform; Payment systems

Indexed keywords

ARTICLE; COST CONTROL; ECONOMICS; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH INSURANCE; HUMAN; METHODOLOGY; ORGANIZATION AND MANAGEMENT; POLITICS; REIMBURSEMENT; STANDARD; UNITED STATES;

COST CONTROL; HEALTH CARE COSTS; HEALTH CARE REFORM; HUMANS; INSURANCE, HEALTH; POLITICS; QUALITY ASSURANCE, HEALTH CARE; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 75149184632     PISSN: 01489917     EISSN: None     Source Type: Journal    
DOI: 10.1097/JAC.0b013e3181c9f437     Document Type: Article

References (31)

1. Averill, R. F., Goldfield, N. I., Hughes, J. S., Eisenhandler, J., & Vertrees, J. C. (2009a). Developing prospective payment system based on episodes of care. Journal of Ambulatory Care Management, 32(3), 241-251.
2. Averill, R., Goldfield, N. I., Muldoon, J., Steinbeck, B., & Grant, T. (2002). A closer look at all patient refined DRGs. Journal of AHIMA/American Health Information Management Association, 73(1), 46-50.
3. Averill, R., Goldfield, N. I.,Wynn, M., McGuire, T., Mullin, R., Gregg, L., et al. (1993). Design of a prospective payment patient classification system for ambulatory care Health Care Financing Review, 15(1), 71-100.
4. Averill, R. F., Grant, T. M., & Steinbeck, B. A. (2000). Preparing for the outpatient prospective payment system. Journal of AHIMA/American Health Information Management Association, 71(7), 35-43.
5. Averill R. F., Hughes J. S., Goldfield N. I., & McCullough E. C. (2009b). Hospital complications: Linking payment reductions to preventability. Joint Commission Journal on Quality and Patient Safety, 35(5), 283-285.
6. Averill, R. F., McCullough, E. C., Hughes, J. S., Goldfield, N. I., Vertrees, J. C., & Fuller, R. L. (2009c). Redesigning the Medicare inpatient PPS to reduce payments to hospitals with high readmission rates. Health Care Financing Review, 30(4), 1-15.
7. Averill, R., Vertrees, J., McCullough, E. C., Hughes, J., & Goldfield, N. (2006). Redesigning the Medicare inpatient PPS to adjust payment for post admission complications. Health Care Financing Review, 27(3), 83-93.
8. Barr, M., & Ginsburg, J. (2006). The advanced medical home: A patient-centered, physician-guided model of health care (Vol. 42, pp. 81-90). Philadelphia: American College of Physicians.
9. Congressional Budget Office. (2007, June 28). Medicare advantage: Private health plans in Medicare. Economic and Budget Issue Brief, p. 5.
10. Coulam, R. F., & Gaumer G. L. (1991). Medicare's prospective payment system: A critical appraisal [Annual supplement]. Health Care Financing Review, 45-77.
11. Elmendorf, D. W. (2009, July 17). Letter to Charles Rangel, Chairman, Committee on Ways and Means, U.S. House of Representatives. Washington, DC: Congressional Budget Office.
12. Federal Register. (2001, May 4). Proposed Rules, 66(87).
13. Federal Register. (2007, August 2). Proposed Rules, 72(148).
14. Federal Register. (2007, August 22). Rules and Regulations, 72(162).
15. Fisher, E. S., McClellan, M. B., Bertko, J., Lieberman, S. M., Lee J. J., Lewis, J. L., et al. (2009). Fostering accountable health care: Moving forward in Medicare. Health Affairs, 28(2), 219-231.
16. Fuller, R. L., McCullough, E. C., Bao, M. Z., & Averill, R. F. (2009). Estimating the cost of potentially preventable hospital acquired complications. Health Care Financing Review, 30(4), 17-32.
17. Goldfield, N. I., Averill, R., Vertrees, J., Fuller, R., Mesches, D., Moore, G., et al. (2008a). Reforming the primary care physician payment system eliminating E & M Vodes and creating the financial incentives for an "Advanced Medical Home." Journal of Ambulatory Care Management, 31(1), 24-31.
18. Goldfield, N. I., McCullough, E. C., Hughes, J. S., Tang, A. M., Eastman, E., Rawlins, L. K., et al. (2008b). Identifying potentially preventable readmissions. Health Care Financing Review, 30(1), 75-91.
19. Halfon, P., Eggli, Y., Pretre-Rohrbach, I., Meyland, D., Marazzi, A., & Burnand, B. (2006). Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care. Medical Care, 44(11), 972-981.
20. Hornbrook, M. C., Hurtado, A. V., & Johnson, R. E. (1985). Health care episodes: Definition, measurement and use. Medical Care Review, 42(2), 163-218.
21. Hughes, J., Averill, R., Eisenhandler, J., Goldfield, N., Muldoon, J., Neff, J., et al. (2003). Clinical Risk Groups (CRGs): A classification system for riskadjusted capitation-based payment and managed care. Medical Care, 42(1), 81-90.
22. Hughes, J., Averill, R., Goldfield, N., Gay, J., Muldoon, J., McCullough, E., et al. (2006). Identifying potentially preventable complications using a present on admission indicator. Health Care Financing Review, 27(3), 63-82.
23. Kaiser Family Foundation. (2008). An analysis of the CMS Medicare current Beneficiary Survey Cost & Use file, 2005, distribution of total Medicare beneficiaries and spending, 2005, Available from the Henry J. Kaiser Foundation Web site, http://facts.kff.org/ chart.aspx?ch-382
24. Kalison, M., & Averill, R. (1984). Regulation vs. contract: the future of capital under PPS. Healthcare Financial Management Monograph Series, 14(5), 104-112.
25. Kalison, M., & Averill, R. (1986). The challenge of "real" competition in Medicare. Health Affairs, 5(3), 47-57.
26. Kalison, M., Surpin, J., & Averill, R. (1999). Align docs', hospitals' money incentives. Modern Health Care, 29, 50, 66.
27. Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., Baker, D. W. (2007). Deficits in communication and information transfer between hospitalbased and primary care physicians. JAMA, 297(8), 831-841.
28. Medicare Payment Advisory Commission. (2008a, March). Update on the Medicare Advantage Program. Medicare Payment Policy [Report to the Congress] Washington, DC: Medicare Payment Advisory Commission.
29. Medicare Payment Advisory Commission. 2008b, June). A Path to Bundled Payment Around a Hospitalization. Medicare Payment Policy [Report to Congress] Washington, DC: Medicare Payment Advisory Commission.
30. Russell, L. B. (1989). Medicare's new hospital payment system: Is it working? Washington, DC: Brookings Institution Press.
31. Schweiker, R. S. (1982, December). Hospital prospective payment for Medicare [Report to Congress].Washington, DC: US Department of Health & Human Services.