The Impact of the Transition From Volume to Value on Heart Failure Care: Implications of Novel Payment Models and Quality Improvement Initiatives

Journal of Cardiac Failure

Volumn 23, Issue 8, 2017, Pages 615-620

  Srinivasan, Dushyanth ^a   Desai, Nihar R ^a,b  

^a YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b YALE NEW HAVEN HOSPITAL   (United States)

Author keywords

healthcare; Payment models; quality care initiatives

Indexed keywords

ACCOUNTABLE CARE ORGANIZATION; COMPOSITE PERFORMANCE SCORE; DIAGNOSIS RELATED GROUP; HEALTH CARE MANAGEMENT; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH CARE UTILIZATION; HEART FAILURE; HEART VOLUME; HOSPITAL READMISSION; HUMAN; MEDICARE; PRIORITY JOURNAL; PURCHASING; REIMBURSEMENT; REVIEW; SCORING SYSTEM; TOTAL QUALITY MANAGEMENT; ECONOMICS; HEALTH CARE COST; TRENDS; UNITED STATES;

HEALTH CARE COSTS; HEART FAILURE; HUMANS; MEDICARE; PATIENT PROTECTION AND AFFORDABLE CARE ACT; QUALITY IMPROVEMENT; UNITED STATES; VALUE-BASED PURCHASING;

EID: 85024114816     PISSN: 10719164     EISSN: 15328414     Source Type: Journal    
DOI: 10.1016/j.cardfail.2017.06.005     Document Type: Review

References (32)

1. Kaiser Family Foundation, Kaiser Family Foundation health facts. 2016.
2. Mayes, R., Berenson, R.A., Medicare prospective payment and the shaping of U.S. health care. 2006, Johns Hopkins University Press, Baltimore.
3. Rajkumar, R., Conway, P.H., Tavenner, M., CMS—engaging multiple payers in payment reform. JAMA 311 (2014), 1967–1968.
4. Blumenthal, D., Jena, A.B., Hospital value-based purchasing. J Hosp Med 8 (2013), 271–277.
5. Sood, N., Huckfeldt, P.J., Escarce, J.J., Grabowski, D.C., Newhouse, J.P., Medicare's bundled payment pilot for acute and postacute care: analysis and recommendations on where to begin. Health Aff (Millwood) 30 (2011), 1708–1717.
6. Tsai, T.C., Joynt, K.E., Wild, R.C., Orav, E.J., Jha, A.K., Medicare's bundled payment initiative: most hospitals are focused on a few high-volume conditions. Health Aff (Millwood) 34 (2015), 371–380.
7. Burwell, S.M., Setting value-based payment goals—HHS efforts to improve U.S. health care. N Engl J Med 372 (2015), 897–899.
8. The Commonwealth Fund, Commonwealth Fund fact sheet. 2016.
9. Joynt, K.E., De Lew, N., Sheingold, S.H., Conway, P.H., Goodrich, K., Epstein, A.M., Should Medicare value-based purchasing take social risk into account?. N Engl J Med 376 (2017), 510–513.
10. Buntin, M.B., Ayanian, J.Z., Social risk factors and equity in Medicare payment. N Engl J Med 376 (2017), 507–510.
11. Centers for Medicare and Medicaid Services, Hospital Value-Based Purchasing. 2017.
12. Joynt, K.E., Orav, E.J., Zheng, J., Jha, A.K., Public reporting of mortality rates for hospitalized Medicare patients. Ann Intern Med 166 (2017), 75–76.
13. Figueroa, J.F., Tsugawa, Y., Zheng, J., Orav, E.J., Jha, A.K., Association between the value-based purchasing pay for performance program and patient mortality in US hospitals: observational study. BMJ, 353, 2016.
14. Centers for Medicare and Medicaid Services, Bundled Payments for Care Improvement (BPCI) initiative. 2017.
15. Weeks, W.B., Rauh, S.S., Wadsworth, E.B., Weinstein, J.N., The unintended consequences of bundled payments. Ann Intern Med 158 (2013), 62–64.
16. Press, M.J., Rajkumar, R., Conway, P.H., Medicare's new bundled payments: design, strategy, and evolution. JAMA 315 (2016), 131–132.
17. Iorio, R., Strategies and tactics for successful implementation of bundled payments: Bundled Payment for Care Improvement at a large, urban, academic medical center. J Arthroplasty 30 (2015), 349–350.
18. Iorio, R., Clair, A.J., Inneh, I.A., Slover, J.D., Bosco, J.A., Zuckerman, J.D., Early results of Medicare's bundled payment initiative for a 90-day total joint arthroplasty episode of care. J Arthroplasty 31 (2016), 343–350.
19. Centers for Medicare and Medicaid Services, Episode Payment Models. 2017.
20. Centers for Medicare and Medicaid Services, MACRA: MIPS & APMs. 2017.
21. Centers for Medicare and Medicaid Services, The Merit-Based Incentive Payment System (MIPS). 2017.
22. Schneider, E.C., Hall, C.J., Improve quality, control spending, maintain access—can the Merit-Based Incentive Payment System deliver?. N Engl J Med 376 (2017), 708–710.
23. Frankel, B.A., Bishop, T.F., A cross-sectional assessment of the quality of physician quality reporting system measures. J Gen Intern Med 31 (2016), 840–845.
24. Burke, T., Accountable care organizations. Public Health Rep 126 (2011), 875–878.
25. Muhlstein, D., McClellen, M., Accountable care organizations in 2016: private and public sector growth and dispersion. Health Affairs Blog, 2016.
26. Centers for Medicare and Medicaid Services, Accountable care organizations (ACO). 2017.
27. McWilliams, J.M., Chernew, M.E., Landon, B.E., Schwartz, A.L., Performance differences in year 1 of pioneer accountable care organizations. N Engl J Med 372 (2015), 1927–1936.
28. McWilliams, J.M., Gilstrap, L.G., Stevenson, D.G., Chernew, M.E., Huskamp, H.A., Grabowski, D.C., Changes in postacute care in the medicare shared savings program. JAMA Intern Med 177 (2017), 518–526.
29. Dupree, J.M., Patel, K., Singer, S.J., West, M., Wang, R., Zinner, M.J., et al. Attention to surgeons and surgical care is largely missing from early Medicare accountable care organizations. Health Aff (Millwood) 33 (2014), 972–979.
30. Patel, K.K., Cigarroa, J.E., Nadel, J., Cohen, D.J., Stecker, E.C., Accountable care organizations: ensuring focus on cardiovascular health. Circulation 132 (2015), 603–610.
31. Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Borden, W.B., et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127 (2013), e6–245.
32. Joynt, K.E., Maddox, T.M., Leading on payment and delivery reform in cardiology. JAMA Cardiol 2 (2017), 121–123.