Policy makers will need a way to update bundled payments that reflects highly skewed spending growth of various care episodes

Health Affairs

Volumn 32, Issue 5, 2013, Pages 944-951

  Rosen, Allison B ^a   Aizcorbe, Ana ^b   Ryu, Alexander J ^c   Nestoriak, Nicole ^d   Cutler, David M ^e   Chernew, Michael E ^c  

^a UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL   (United States)

^b Bureau of Economic Analysis   (United States)

^c HARVARD MEDICAL SCHOOL   (United States)

^d BUREAU OF LABOR STATISTICS   (United States)

^e HARVARD UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; FEMALE; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH CARE UTILIZATION; HEALTH INSURANCE; HUMAN; KNOWLEDGE; MAJOR CLINICAL STUDY; MALE; PRESCRIPTION; REIMBURSEMENT; SLEEP DISORDER;

HEALTH ECONOMICS;

ADOLESCENT; ADULT; EPISODE OF CARE; FEMALE; HEALTH CARE COSTS; HEALTH EXPENDITURES; HEALTH POLICY; HUMANS; MALE; MEDICAID; MEDICARE; MIDDLE AGED; PATIENT CARE BUNDLES; POLICY MAKING; REIMBURSEMENT MECHANISMS; UNITED STATES; YOUNG ADULT;

EID: 84877938509     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2012.1246     Document Type: Article

References (14)

1. A summary of nineteen high-profile public and private bundled payment experiments is provided in: Bailit MH, Burns ME, Painter MW. Bundled payment across the US today: status of implementations and operational findings [Internet]. Newtown (CT): Health Care Incentives Improvement Institute; 2012 [cited 2013 Apr 1]. (Issue Brief). Available from: http://www.hci3.org/sites/default/files/files/HCI-IssueBrief-4-2012.pdf
2. Center for Medicare and Medicaid Innovation. Bundled Payments for Care Improvement (BPCI) initiative: general information [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; 2011 [cited 2013 Apr 1]. Available from: http://innovations.cms.gov/initiatives/bundled-payments/
3. Emanuel EJ. The Arkansas innovation. New York Times. 2012 Sep 5.
4. Hussey PS, Ridgely MS, Rosenthal MB. The PROMETHEUS bundled payment experiment: slow start shows problems in implementing new payment models. Health Aff (Millwood). 2011;30(11):2116-24.
5. For example, see the critiques of the Resource Utilization Committees (RUCs) used for physician payment: Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med. 2007;146(4):301-6.
6. For a more detailed description of two other widely used commercial episode groupers, see MaCurdy T, Kerwin J, Gibbs J, Lin E, Cotterman C, O'Brien-Strain M, et al. Evaluating the functionality of the Symmetry ETG and Medstat MEG software in forming episodes of care using Medicare data [Internet]. Burlingame (CA): Acumen LLC; 2008 [cited 2013 Apr 1]. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/MaCurdy.pdf
7. Direct adjustment was used to standardize age and sex to 2003 levels to account for spending growth attributable solely to demographic changes in the population.
8. To access the Appendix, click on the Appendix link in the box to the right of the article online.
9. The 196 chronic episodes included 6 chronic maintenance episodes, 6 exacerbation of chronic condition episodes, and 184 chronic nonstratified episodes.
10. Centers for Medicare and Medicaid Services. National health expenditure projections 2008-2018 [Internet]. Baltimore (MD): CMS; 2009 [cited 2013 Apr 1]. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/proj2008.pdf
11. Medicare Payment Advisory Commission. Report to the Congress: reforming the delivery system. Washington (DC): MedPAC; 2008 Jun [cited 2013 Apr 1]. Available from: http://www.medpac.gov/documents/jun08_entirereport.pdf
12. Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood). 2008;27(5):1235-45.
13. Robert Wood Johnson Foundation [Internet]. Princeton (NJ): RWJF; c2001-13. Press release, PROMETHEUS Payment set to test new model of paying providers for high-quality health care; 2008 May 21 [cited 2013 Apr 1]. Available from: http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2008/05/prometheus-payment-setto-test-new-method-of-payingproviders-fo.html
14. Our result is not comparable to that reported in the literature because we did not deflate spending, as is typically done.