Will bundled payments change health care?: Examining the evidence thus far in cardiovascular care

Circulation

Volumn 131, Issue 24, 2015, Pages 2151-2158

  Shih, Terry ^a,b   Chen, Lena M ^a,b,c   Nallamothu, Brahmajee K ^a,b,c  

^a UNIVERSITY OF MICHIGAN   (United States)

^b UNIVERSITY OF MICHIGAN MEDICAL SCHOOL   (United States)

^c VA ANN ARBOR HEALTHCARE SYSTEM   (United States)

Author keywords

Health care costs; Health policy; Health services research; Outcome assessment (health care)

Indexed keywords

ARTICLE; BUNDLED PAYMENT; CARDIOLOGY; HEALTH CARE COST; HUMAN; MEDICAL FEE; PRIORITY JOURNAL; CARDIOVASCULAR DISEASES; CORONARY ARTERY BYPASS GRAFT; COST CONTROL; ECONOMICS; EVIDENCE BASED PRACTICE; GOVERNMENT; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH ECONOMICS; INTEGRATED HEALTH CARE SYSTEM; MEDICARE; ORGANIZATION AND MANAGEMENT; OUTCOME ASSESSMENT; PATIENT CARE; PROSPECTIVE PAYMENT; REIMBURSEMENT; STATISTICAL MODEL; TOTAL QUALITY MANAGEMENT; TRENDS; UNITED STATES;

CARDIOVASCULAR DISEASES; CENTERS FOR MEDICARE AND MEDICAID SERVICES (U.S.); CORONARY ARTERY BYPASS; COST SAVINGS; DELIVERY OF HEALTH CARE, INTEGRATED; ECONOMICS, HOSPITAL; EPISODE OF CARE; EVIDENCE-BASED PRACTICE; HEALTH CARE COSTS; HEALTH CARE REFORM; HEALTH RESOURCES; HUMANS; INSURANCE, HEALTH, REIMBURSEMENT; MEDICARE; MODELS, ECONOMIC; OUTCOME ASSESSMENT (HEALTH CARE); PATIENT CARE TEAM; PROSPECTIVE PAYMENT SYSTEM; QUALITY IMPROVEMENT; UNITED STATES;

EID: 84936109277     PISSN: 00097322     EISSN: 15244539     Source Type: Journal    
DOI: 10.1161/CIRCULATIONAHA.114.010393     Document Type: Article

References (30)

1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014;129:e28-e292. doi: 10.1161/01.cir.0000441139.02102.80.
2. Miller DC, Gust C, Dimick JB, Birkmeyer N, Skinner J, Birkmeyer JD. Large variations in Medicare payments for surgery highlight savings potential from bundled payment programs. Health Aff (Millwood). 2011;30:2107-2115. doi: 10.1377/hlthaff.2011.0783.
3. Chandra A, Dalton MA, Holmes J. Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings. Health Aff (Millwood). 2013;32:864-872. doi: 10.1377/hlthaff.2012.1262.
4. Mechanic R. Post-acute care: the next frontier for controlling Medicare spending. N Engl J Med. 2014;370:692-694. doi: 10.1056/NEJMp1315607.
5. Miller HD. From volume to value: better ways to pay for health care. Health Aff (Millwood). 2009;28:1418-1428. doi: 10.1377/hlthaff.28.5.1418.
6. Eappen S, Lane BH, Rosenberg B, Lipsitz SA, Sadoff D, Matheson D, Berry WR, Lester M, Gawande AA. Relationship between occurrence of surgical complications and hospital finances. JAMA. 2013;309:1599-1606. doi: 10.1001/jama.2013.2773.
7. Medicare Payment Advisory Commission. Report to the Congress: Reforming the delivery system. 2008. http://www.medpac.gov/documents/Jun08-EntireReport.pdf. Accessed July 30, 2014.
8. Chulis GS. Assessing Medicare's prospective payment system for hospitals. Med Care Rev. 1991;48:167-206.
9. Lave JR. The effect of the Medicare prospective payment system. Annu Rev Public Health. 1989;10:141-161. doi: 10.1146/annurev.pu.10.050189.001041.
10. White C. Why did Medicare spending growth slow down? Health Aff (Millwood). 2008;27:793-802. doi: 10.1377/hlthaff.27.3.793.
11. Feinglass J, Holloway JJ. The initial impact of the Medicare prospective payment system on U.S. health care: a review of the literature. Med Care Rev. 1991;48:91-115.
12. Edmonds C, Hallman GL. CardioVascular Care Providers: a pioneer in bundled services, shared risk, and single payment. Tex Heart Inst J. 1995;22:72-76.
13. Cromwell J, Dayhoff DA, Thoumaian AH. Cost savings and physician responses to global bundled payments for Medicare heart bypass surgery. Health Care Financ Rev. 1997;19:41-57.
14. Cromwell J, Dayhoff DA, McCall NT, Subramanian S, Freitas RC, Hart RJ, Caswell C, Stason W. Medicare participating heart bypass demonstration. executive summary: final report. 1998. http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/Medicare-Heart-Bypass-Executive-Summary.pdf. Accessed July 30, 2014.
15. Casale AS, Paulus RA, Selna MJ, Doll MC, Bothe AE Jr, McKinley KE, Berry SA, Davis DE, Gilfillan RJ, Hamory BH, Steele GD Jr. "ProvenCareSM": a provider-driven pay-for-performance program for acute episodic cardiac surgical care. Ann Surg. 2007;246:613-621. doi: 10.1097/SLA.0b013e318155a996.
16. Abelson R. In bid for better care, surgery with a warranty. New York Times. 2007. http://www.nytimes.com/2007/05/17/business/17quality.html?-r=2&. Accessed July 30, 2014.
17. Abrams L. Where surgery comes with a 90-day guarantee. The Atlantic. 2012. http://www.theatlantic.com/health/archive/2012/09/where-surgerycomes-with-a-90-day-guarantee/262841/. Accessed July 30, 2014.
18. Lee TH. Pay for performance, version 2.0? N Engl J Med. 2007;357:531-533. doi: 10.1056/NEJMp078124.
19. Understanding ProvenCare Services. http://www.geisinger.org/sites/provencare/pages/provencare-services.html. Accessed May 22, 2015.
20. Centers for Medicare & Medicaid Services. Medicare Acute Care Episode Demonstration for orthopedic and cardiovascular surgery. https://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/ACE-web-page.pdf. Accessed July 30, 2014.
21. Centers for Medicare & Medicaid Services. Evaluation of the Medicare Acute Care Episode (ACE) demonstration. 2013. http://downloads.cms.gov/files/cmmi/ACE-EvaluationReport-Final-5-2-14.pdf. Accessed July 30, 2014.
22. Calsyn M, Emanuel EJ. Controlling costs by expanding the Medicare Acute Care Episode demonstration. JAMA Intern Med. 2014;174:1438-1439. doi: 10.1001/jamainternmed.2014.2981.
23. de Brantes F, Rosenthal MB, Painter M. Building a bridge from fragmentation to accountability: the Prometheus Payment model. N Engl J Med. 2009;361:1033-1036. doi: 10.1056/NEJMp0906121.
24. PROMETHEUS Payment: on the frontlines of health care payment reform. 2010. http://www.rwjf.org/content/dam/farm/reports/issue-briefs/2010/rwjf63464. Accessed July 30, 2014.
25. Hussey PS, Ridgely MS, Rosenthal MB. The PROMETHEUS bundled payment experiment: slow start shows problems in implementing new payment models. Health Aff (Millwood). 2011;30:2116-2124. doi:10.1377/hlthaff.2011.0784.
26. Health Care Incentives Improvement Institute. PROMETHEUS in time: current status of implementations and analytic activities around the nation. http://www.hci3.org/content/prometheus-time-current-status-implementations-and-analytic-activities-around-nation. Accessed July 30, 2014.
27. Health Care Incentives Improvement Institute. The progression of PROMETHEUS Payment. http://www.hci3.org/sites/default/files/files/ThatWasThenThisIsNow-2011-11-10.pdf. Accessed July 30, 2014.
28. Centers for Medicare & Medicaid Services. Bundled Payments for Care Improvement (BPCI) initiative: general information. http://innovation.cms.gov/initiatives/bundled-payments/. Accessed July 30, 2014.
29. Tsai TC, Joynt KE, Orav EJ, Jha AK. Opportunities for savings in the Bundled Payments for Care Improvement initiative. Paper presented at: Academy Health Annual Research Meeting. San Diego, CA; June 9, 2014. http://www.academyhealth.org/files/2014/monday/tsai2.pdf. Accessed July 30, 2014.
30. Ridgely MS, de Vries D, Bozic KJ, Hussey PS. Bundled payment fails to gain a foothold In California: the experience of the IHA bundled payment demonstration. Health Aff (Millwood). 2014;33:1345-1352. doi: 10.1377/hlthaff.2014.0114.