Bundle Payment for Musculoskeletal Care

Piccinin, Meghan A.; Sayeed, Zain; Kozlowski, Ryan J.; Bobba, Vamsy; Knesek, David; Frush, Todd

doi:10.1016/j.ocl.2017.11.002

Cited by 39 publications

(26 citation statements)

References 100 publications

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“…2). Similar findings have shown telehealth can play a significant role in cost savings and effectiveness compared with in-person care for total knee arthroplasty [11,12,16,17,19]. Historically, CMS did not recognize physical therapists as telehealth providers, thereby limiting the ability to expand to other patients and service lines.…”

Section: Pre-covid-19 Eramentioning

confidence: 73%

Pivoting to Telehealth: the HSS Experience, Value Gained, and Lessons Learned

2020

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Section: Pre-covid-19 Eramentioning

confidence: 73%

Pivoting to Telehealth: the HSS Experience, Value Gained, and Lessons Learned

2020

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“…For example, ineffective performance-based payment mechanisms do not necessarily promote quality of care in pain management, such as those utilizing patients’ satisfaction scores or experience of care. Perhaps, this is one of the reasons that mechanisms like bundled payments are becoming more common in pain management among both CMS and private insurance companies [ 130 ]. As another example, we note that many initiatives aimed at curbing the supply of opioids have not addressed how patients in dire pain conditions have been impacted [ 131 ].…”

Section: Discussionmentioning

confidence: 99%

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

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“…The absence of such a collaborative relationship makes meaningful clinical and economic evaluation very difficult 46 47. Reimbursement contracts that include outcomes will stimulate the VBHC approach and promote bundled pathways that deliver it 48 49. Accurate economic evaluation forms the denominator to the value equation and considering the merits of TDABC against PLICS is important going forward 38 40 50.…”

Section: Discussionmentioning

confidence: 99%

Value-based healthcare analysis of joint replacement surgery for patients with primary hip osteoarthritis

et al. 2019

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BackgroundA quarter of the population present at least once a year with a musculoskeletal disorder. Primary hip osteoarthritis is a high-volume condition with significant clinical need and population-level costs. There remains much variation in patient outcomes and care delivery costs for this condition.AimsThe study aimed to gauge if pathway redesign based on the principles of value-based healthcare (VBHC) could increase value. The aim was to calculate the value of treatment for primary hip osteoarthritis through measuring outcomes that matter to patients, as well as the costs of delivering them. Additionally it aimed to compare two care pathways to identify which elements may better promote the delivery of high-value clinical care.MethodsTwo care models were evaluated: the first being a traditional model with multiple entry points and without pathway standardisation, and the second an intentionally designed standardised multidisciplinary pathway. Mandated National Health Service patient-reported outcomes were assessed but were restructured into a patient-centred format to assess the impact on pain, function and psychological outcomes. Patient-level pathway economic evaluation was performed. Using these data, outcomes were mapped against cost to calculate value.ResultsThere were no significant differences in clinical outcomes between the two models. The intentionally designed model delivered better value care, having lower pathway costs. This model produced a small but inconsistent positive financial margin.ConclusionsIntentionally designed, integrated elective services offer an opportunity to develop and evaluate VBHC models. Analysis of two care pathways from a VBHC perspective demonstrated that an intentionally designed pathway had higher value. The higher value pathway maximised the benefits of having physiotherapists and orthopaedic surgeons working side by side. Developing and measuring patient-orientated outcomes and performing accurate economic evaluation are the key to understanding and achieving better value care.

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Bundle Payment for Musculoskeletal Care

Cited by 39 publications

References 100 publications

Pivoting to Telehealth: the HSS Experience, Value Gained, and Lessons Learned

Pivoting to Telehealth: the HSS Experience, Value Gained, and Lessons Learned

Misalignment of Stakeholder Incentives in the Opioid Crisis

Value-based healthcare analysis of joint replacement surgery for patients with primary hip osteoarthritis

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