A pain relieving reimbursement program? Effects of a value-based reimbursement program on patient reported outcome measures

Abstract

Background Value-based reimbursement programs have become increasingly common. However, little is known about the effect of such programs on patient reported outcomes. Thus, the aim of this study was to analyze the effect of introducing a value-based reimbursement program on patient reported outcome measures and to explore whether a selection bias towards less complicated patients occurred. Methods This is a retrospective observational study with a before and after design based on the introduction of a value-based reimbursement program in Region Stockholm, Sweden. We analyzed patient level data from inpatient and outpatient care of patients undergoing lumbar spine surgery during 2006–2015. Patient reported outcome measures used was Global Assessment, EQ-5D-3L and Oswestry Disability Index. The case-mix of surgically treated patients was analyzed using medical and socioeconomic factors. Results The value-based reimbursement program did not have any effect on targeted or non-targeted patient reported outcome measures. Moreover, the share of surgically treated patients with risk factors such as having comorbidities and being born outside of Europe increased after the introduction. Hence, the value-based reimbursement program did not encourage discrimination against sicker patients. However, the income was higher among patients surgically treated after the introduction of the value-based reimbursement. This indicates that a value-based reimbursement program may contribute to increased inequalities in access to healthcare. Conclusions The value-based reimbursement program did not have any effect on patient reported outcome measures. Our study contributes to the understanding of the effects of a value-based reimbursement program on patient reported outcome measures and to what extent cherry-picking arises.

The effects of competition and bundled payment on patient reported outcome measures after hip replacement surgery

“…In their study on a similar competition-inducing reform with a bundle payment arrangement introduced in Stockholm, but for elective spine surgery, Eriksson and colleagues [ 15 ] also found no effects on PROMs. As they discuss in their paper, one reason for the lack of effect relates to the incentive structure.…”

“…As they discuss in their paper, one reason for the lack of effect relates to the incentive structure. Within the spine surgery program, providers were given stronger financial incentives to avoid negative outcomes than to reach positive outcomes [ 15 ]. This is also the case for the reform being analyzed in the present paper.…”

“…A few recent studies have investigated the competition-induced reforms to the English National Health Service, where Skellern [ 13 ] found negative effects on PROMs of health gains for hip and knee replacement patients, whereas Feng et al [ 14 ] found no association between increased competition and patient-reported health gains for hip replacements. Furthermore, the effects of economic incentives on PROMs have been analyzed in a study considering a value-based reimbursement program for spine surgery in Sweden, though no effects were found [ 15 ]. Lastly, a recent study found that patients at hospitals participating in Medicare’s bundled payment programs do not have meaningfully worse improvements in PROMs after hip or knee replacement as patients at non-participating hospitals [ 16 ].…”

A public health value-based healthcare paradigm for HIV

“…The combination of a value-oriented payment system with a comprehensive definition of value can stimulate cross-healthcare collaboration. By making healthcare actors financially responsible for delivering the outcomes that matter, providing efficient pathways to deliver this value is incentivized [ 30 ]. The careful integration of outcome, process, and structure indicators can be used to direct and safeguard VBHC implementation to make sure the focus on delivering value is not lost in translation.…”

Correction to: A pain relieving reimbursement program? Effects of a value-based reimbursement program on patient reported outcome measures

“…Following publication of the original article [ 1 ], the authors identified some errors in Table 6 . The correct table and caption have been included in this correction, and the original article has been corrected.…”