Controlling costs without compromising quality: Paying hospitals for total knee replacement

Medical Care

Volumn 48, Issue 10, 2010, Pages 862-868

  Pine, Michael ^a,b   Fry, Donald E ^a,c   Jones, Barbara L ^a   Meimban, Roger J ^a   Pine, Gregory J ^a  

^a Michael Pine and Associates   (United States)

^b UNIVERSITY OF CHICAGO   (United States)

^c NORTHWESTERN UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST BENEFIT ANALYSIS; COST EFFECTIVENESS ANALYSIS; HEALTH CARE COST; HEALTH CARE QUALITY; HEALTH CARE UTILIZATION; HOSPITAL CARE; HOSPITAL COST; HUMAN; LENGTH OF STAY; PRIORITY JOURNAL; PROSPECTIVE PAYMENT; QUALITY CONTROL; TOTAL KNEE REPLACEMENT; ADULT; AGED; COST CONTROL; ECONOMICS; FEMALE; HOSPITAL CHARGE; KNEE ARTHROPLASTY; KNEE OSTEOARTHRITIS; MALE; MEDICAL FEE; MIDDLE AGED; ORGANIZATION AND MANAGEMENT; REIMBURSEMENT; STATISTICS AND NUMERICAL DATA; UNITED STATES; VERY ELDERLY; YOUNG ADULT;

ADULT; AGED; AGED, 80 AND OVER; ARTHROPLASTY, REPLACEMENT, KNEE; COST CONTROL; COST-BENEFIT ANALYSIS; EFFICIENCY, ORGANIZATIONAL; FEE-FOR-SERVICE PLANS; FEMALE; HOSPITAL CHARGES; HOSPITAL COSTS; HUMANS; LENGTH OF STAY; MALE; MIDDLE AGED; OSTEOARTHRITIS, KNEE; REIMBURSEMENT MECHANISMS; UNITED STATES; YOUNG ADULT;

EID: 77957280689     PISSN: 00257079     EISSN: None     Source Type: Journal    
DOI: 10.1097/MLR.0b013e3181eb3176     Document Type: Article

References (26)

1. Anderson GF, Frogner BK, Reinhardt UE. Health spending in OECD countries in 2004: an update. Health Aff. 2007;26:1481-1489.
2. Zuvekas SH, Cohen JW. Prescription drugs and the changing concentration of health care expenditures. Health Aff. 2007;26:249-257.
3. Jones RS, Brown C, Opelka F. Surgeon compensation: "pay for performance," the American College of Surgeons National Surgical Quality Improvement Program, the Surgical Care Improvement Program, and other considerations. Surgery. 2005;138:829-836.
4. Rosenthal MB, Frank RG, Li Z, et al. Early experience with pay-for-performance: from concept to practice. JAMA. 2005;294:1788-1793.
5. Petersen LA, Woodard LD, Urech T, et al. Does pay-for-performance improve the quality of health care? Ann Intern Med. 2006;145:695-699.
6. Congressional Budget Office. Letter to Congressman Steny H. Hoyer; July 25,2009. Availableat:http://www.cbo.gov/ftpdocs/104xx/doc10480/07-25-IMAC.pdf.
7. The United States House of Representatives. Affordable Health Care for Americans Act. HR3962. Available at: http://docs.house.gov/rules/health/111- ahcaa.pdf
8. The Senate of the United States. Patient Protection and Affordable Care Act. HR 3590 (with Senate Amendments). Available at: http://www. opencongress.org/senate-health-care-bill.
9. Hackbarth G, Reischauer R, Mutti A. Collective accountability for medical care-toward bundled Medicare payments. N Engl J Med. 2008; 359:3-5.
10. Center for Medicare and Medicaid Services: Medicare acute care episode demonstration. 2009. Available at: http://www.cms.hhs.gov/Demo ProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDID=\ 99&sortByDID = 3&sortOrder=descending&itemID=CMS1204388 &intNumPerPage= 10.
11. Casale AS, Paulus RA, Selna MJ, et al. Proven care: a provider-driven pay-for-performance program for acute episodic cardiac surgical care. Ann Surg. 2007;246:613-623.
12. HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2005. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp.
13. Friedman B, De La Mare J, Andrews R, et al. Practical options for estimating cost of hospital inpatient stays. J Health Care Finance. 2002;29:1-13.
14. Elixhauser A, Steiner C, Harris D, et al. Comorbidity measures for use with administrative data. Med Care. 1998;36:8-27.
15. Fry DE, Pine M, Jones BL, et al. Adverse outcomes in surgery: redefinition of post-operative complications. Am J Surg. 2009;197:479-484.
16. SAS. Statistics: powerful tools for both specialized and enterprise analyticalneeds.Availableat:http://www.sas.com/technologies/analytics/ statistics/index.html. Accessed June 23, 2008.
17. Agency for Healthcare Research and Quality. Introduction to the HCUP nationwide inpatient sample (NIS); 2007. Available at: http://www.hcup-us.ahrq. gov/db/nation/nis/NIS-2007-INTRODUCTION.pdf.
18. Fry DE, Pine M, Jordan HS, et al. Combining administrative and clinical data to stratify surgical risk. Ann Surg. 2007;246:875-885.
19. Pine M, Jordan HS, Elixhauser A, et al. Enhancement of claims data to improve risk adjustment of hospital mortality. JAMA. 2007;297:71-76.
20. Diehr P, Yanez D, Ash A, et al. Methods for analyzing health care utilization and costs. Annu Rev Public Health. 1999;20:125-144.
21. Sokol DK, Wilson J. What is a surgical complication? World J Surg. 2008;32:942-944.
22. Staiger DO, Dimick JB, Baser O, et al. Empirically derived composite measures of surgical performance. Med Care. 2009;47:226-233.
23. Fisher ES, Staiger DO, Bynum JP, et al. Creating accountable care organizations: the extended hospital medical staff. Health Aff. 2006;26:w44-w57.
24. Centers for Medicare and Medicaid Services. CMS improves patient safely for Medicare and Medicaid by addressing never events. Available at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter= 3224 &intNumPerPage= 10&checkDate=&checkKey=&srchType= 1&num Days=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType =6&intPage=&showAll=&pYear=&year=&desc=false&cboOrder= date.
25. De Brantes F, D'Andrea G, Rosenthal MB. Should health care come with a warranty? Health Aff. 2009;28:w678-w687.
26. Rastogi A, Mohr BA, Williams JO, et al. Prometheus payment model: application to hip and knee replacement surgery. Clin Orthop Relat Res. 2009;467:2587-2597.