Surgeon Participation in Early Accountable Care Organizations

Resnick, Matthew J.; Graves, Amy J.; Buntin, Melinda Beeuwkes; Richards, Michael R.; Penson, David F.

doi:10.1097/sla.0000000000002233

Cited by 32 publications

(27 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Value-based medicine aims at measuring quality of care with endpoints relevant to patients and society as a whole. 1,2 Although quality of care at acceptable costs is ubiquitously the target of accountable health care systems, the definition of quality remains imprecise, and therefore subjected to versatile interpretation, or even manipulation, depending on the perspectives. For example, a country might be satisfied with a goal of spending less than 10% of gross domestic product (GDP), while another may value offering free health care to all its inhabitants.…”

mentioning

confidence: 99%

Toward a Consensus on Centralization in Surgery

et al. 2018

View full text Add to dashboard Cite

There is an obvious need in most areas for effective centralization. Unrestrained, purely "market driven" approaches are deleterious to patients and society. Centralization should not be based solely on minimal number of procedures, but rather on the multidisciplinary treatment of complex diseases including well-trained specialists available around the clock. Audited prospective database with monitoring of quality of care and cost are mandatory.

show abstract

mentioning

confidence: 99%

Toward a Consensus on Centralization in Surgery

et al. 2018

View full text Add to dashboard Cite

show abstract

“…1 Accountable Care Organizations and other similar models are organized so that the hospitals assume the total costs of patient care and are reimbursed a fixed amount. 2,3 It is unclear how this will affect hospital systems, and in particular safety net hospitals, which currently take care of a higher percentage of uninsured and underinsured patients. 4,5 Patients in these hospitals tend to have fewer resources and social support and, as such, these institutions may be at risk for being disproportionately penalized, because they have been historically shown to have higher perioperative readmission rates.…”

mentioning

confidence: 99%

Short- and long-term readmission rates after infrainguinal bypass in a safety net hospital are higher than expected

Krafcik

Komshian

et al. 2017

Journal of Vascular Surgery

View full text Add to dashboard Cite

Short- and long-term readmission rates in a safety net setting are high. The 30-day rates in this study are higher than historically reported. This data sets baseline rates for 90-day and 1-year readmission for future analyses. Although the majority of short-term readmissions are related to the index procedure, long-term readmission rates are more frequently related to systemic comorbidities. Targeted patient interventions aimed at preventing the most common reasons for readmission may improve readmission rates, particularly among patients with nonprivate insurance. However, other risk factors, such as tibial target, may not be modifiable and a higher readmission rate may need to be accepted in this population.

show abstract

“…For example, researchers estimate that only 22.3% of surgeons are involved with accountable care organizations with considerably variability by specialty. 2 Plausible explanations include a lack of surgery-specific quality measures, misaligned incentives, and poor surgeon representation in model governance. Condition-based bundled payment models and decentralized delivery systems create opportunities to properly integrate surgeons into the broader VBC ecosystem.…”

Section: Frontiers For Value: From Outbreaks To Outcomesmentioning

confidence: 99%

“…Yet, surgeons continue to be underrepresented in the design and deployment of VBC models such as accountable care organizations, which in turn have been unable to move the needle on surgical costs. 2 , 3 Even for VBC initiatives targeting surgery – such as bundled payments – the changes in clinical practice have largely been downstream from surgical care (eg, post-acute referrals). 4…”

mentioning

confidence: 99%