A bundled payment framework for colonoscopy performed for colorectal cancer screening or surveillance

Gastroenterology

Volumn 146, Issue 3, 2014, Pages

  Brill, Joel V ^a   Jain, Rajeev ^b   Margolis, Peter S ^c   Kosinski, Lawrence R ^d   Holt Jr , Worthe S ^e   Ketover, Scott R ^f   Kim, Lawrence S ^g   Clote, Laura E ^h   Allen, John I ⁱ  

^a Predictive Health LLC   (United States)

^b Texas Digestive Disease Consultants   (United States)

^c University Gastroenterology   (United States)

^d Illinois Gastroenterology Group   (United States)

^e HUMANA INC   (United States)

^f Minnesota Gastroenterology   (United States)

^g South Denver Gastroenterology   (United States)

^h American Gastroenterological Association   (United States)

ⁱ YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CANCER EPIDEMIOLOGY; CANCER SCREENING; COLONOSCOPY; COLORECTAL CANCER; CONCEPTUAL FRAMEWORK; FOLLOW UP; HEALTH CARE COST; HOSPITAL PATIENT; HUMAN; ICD-10; ICD-9; MEDICAID; MEDICARE; OUTPATIENT CARE; POSTOPERATIVE PERIOD; PRIORITY JOURNAL;

COLONOSCOPY; COLORECTAL NEOPLASMS; EARLY DETECTION OF CANCER; EPIDEMIOLOGICAL MONITORING; FEE-FOR-SERVICE PLANS; HUMANS; INCIDENCE; MODELS, ECONOMIC; PATIENT CARE BUNDLES; PATIENT PROTECTION AND AFFORDABLE CARE ACT; UNITED STATES;

EID: 84894305255     PISSN: 00165085     EISSN: 15280012     Source Type: Journal    
DOI: 10.1053/j.gastro.2014.01.043     Document Type: Article

References (45)

1. 42 CFR Parts 405, 410, 411, et al. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014; Final Rule 78 FR 74230-74823.
2. The Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152).
3. R.A. Berenson, and D.R. Kaye Grading a physician's value- the misapplication of performance measurement N Engl J Med 369 2013 2079 2081
4. Rosenthal E. The $2.7 trillion medical bill. Colonoscopies explain why U.S. leads the world in health expenditures. The New York Times June 1, 2013:A1.
5. G.A. Cuckler, A.M. Sisko, and S.P. Keehan et al. National health expenditure projections, 2012-22: slow growth until coverage expands and economy improves Health Aff 32 2013 1820 1831
6. M.E. Porter, and E.O. Teisberg Redefining health care: creating value-based competition on results 2006 Harvard Business School Press Cambridge, MA
7. J.C. Robinson, and K. MacPherson Payers test reference pricing and centers of excellence to steer patients to low-price and high-quality providers Health Aff 31 2012 2028 2036
8. Reinhardt UW. The sleeper in health care payment reform. New York Times August 2, 2013.
9. Ahlquist GD, Javanmardian M, Saxena SB. Healthcare shifts from à la carte to prix fixe. Strategy+Business November 12, 2013.
10. Vesely R. An ACE in the deck? Bundled-payment demo shows returns for hospitals, physicians, patients. Modern Healthcare. February 7, 2011.
11. P.S. Hussey, M.E. Sorbero, and A. Mehrotra et al. Episode-based performance measurement and payment: making it a reality Health Aff 28 2009 1406 1417
12. Delbanco SF, Anderson KM, Major CE, et al. Promising payment reform: risk-sharing with accountable care organizations. The Commonwealth Fund, July 2011.
13. R.A. Paulus, K. Davis, and G.D. Steele Continuous innovation in health care: implications of the Geisinger experience Health Aff 27 2008 1235 1245
14. J.A. Allen The road ahead Clin Gastroenterol Hepatol 10 2012 692 696
15. American Gastroenterological Association. Roadmap to the future of GI. Available at: http://www.gastro.org/practice/roadmap-to-the-future-of-gi.
16. C. Stock, M. Hoffmeister, and B. Birkner et al. Inter-physician variation in follow-up colonoscopies after screening colonoscopy PLoS One 8 2013 e69312
17. S.D. Saini, R.S. Nayak, and L. Kuhn et al. Why don't gastroenterologists follow colon polyp surveillance guidelines? Results of a national survey J Clin Gastroenterol 43 2009 554 558
18. J.S. Goodwin, A. Singh, and N. Reddy et al. Overuse of screening colonoscopy in the Medicare population Arch Intern Med 171 2011 1335 1343
19. C.W. Ko, J.A. Dominitz, and P. Green et al. Utilization and predictors of early repeat colonoscopy in Medicare beneficiaries Am J Gastroenterol 105 2010 2670 2679
20. W. Frist, S. Schroeder, and J. Bigby et al. Report of the National Commission on Physician Payment Reform March 2013 National Commission on Physician Payment Reform Washington, DC
21. D.A. Cooley, and J.W. Adams Package pricing at the Texas Heart Institute. Consumer-driven health care: implications for providers, payers and policymakers 2004 Jossey-Bass San Francisco, CA 612 619
22. J.C. Robinson, and T.T. Brown Increases in consumer cost sharing redirect patient volumes and reduce hospital prices for orthopedic surgery Health Aff 32 2013 1392 1397
23. D. Moeller Building your automated bundled payment for an episode-of-care initiative Am Health Drug Benefits 4 2011 403 405
24. F. de Brantes, and J.A. Camillus Evidence-informed case rates: a new health care payment model 2007 Commonwealth Fund New York, NY
25. R.E. Mechanic, and S.H. Altman Payment reform options: episode payment is a good place to start Health Aff 28 2009 262 271
26. N.N. Baxter, R. Sutradhar, and S.S. Forbes et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer Gastroenterology 140 2011 65 72
27. D.A. Lieberman, M. Nadel, and R.A. Smith et al. Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable Gastrointest Endosc 65 2007 757 766
28. D.A. Lieberman, D.O. Faigel, and J.R. Logan et al. Assessment of the quality of colonoscopy reports: results from a multicenter consortium Gastrointest Endosc 69 2009 645 653
29. D.K. Rex, J.L. Petrini, and T.H. Baron et al. ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for colonoscopy Am J Gastroenterol 101 2006 873 885
30. G. Amundsen Individual physician colonoscopy quality reporting February 2013 Quality Quest for Health Peoria, IL
31. National Colorectal Cancer Roundtable. November 2013. Available at: http://nccrt.org/about/quality/accreditation-program.
32. Fennerty MB. Quality colonoscopy: how do you let your patients know you meet the mark? NEJM Journal Watch December 30, 2012.
33. H. Burstin Consensus Standards Approval Committee: memo on colonoscopy quality index measure review July 2, 2013 National Quality Forum Washington, DC
34. A. Qaseem, P. Alguire, and P. Dallas et al. Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care Ann Intern Med 156 2012 147 149
35. D.K. Owens, A. Qaseem, and R. Chou et al. Clinical Guidelines Committee of the American College of Physicians. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions Ann Intern Med 154 2011 174 180
36. L.F. McMahon, and V. Chopra Health care cost and value: the way forward JAMA 307 2012 671 672
37. A.D. Sinaiko, and M.B. Rosenthal Increased price transparency in health care - challenges and potential effects N Engl J Med 364 2011 891 894
38. J.H. Hibbard, J. Greene, and S. Sofaer et al. An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care Health Aff 31 2012 560 568
39. A.M. Haviland, N. Sood, and R. McDevitt et al. The effects of consumer-direct health plans on episodes of health care Forum Health Econ Policy 14 2011 1 27
40. J.I. Allen Health care reform 3.0: the road gets bumpy Clin Gastroenterol Hepatol 11 2013 1527 1528
41. J.I. Allen The value of colonoscopy Gastroenterology 146 2014 573 575
42. D.A. Lieberman, D.K. Rex, and S.J. Winawer et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer Gastroenterology 143 2012 844 857
43. D.K. Rex, C.J. Cahi, and B. Levin et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer Gastroenterology 130 2006 1865 1871
44. T. Anthony, C. Simmang, and N. Hyman et al. Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer Dis Colon Rectum 47 2004 807 817
45. D.A. Lieberman, M. Nadel, and R.A. Smith et al. Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable Gastrointest Endosc 65 2007 757 766