Including Physicians in Bundled Hospital Care Payments

Mehrotra, Ateev; Hussey, Peter S.

doi:10.1001/jama.2015.3359

Cited by 24 publications

(11 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8 The second disadvantage of hospital discharge datasets is that they typically report only facility charges billed by hospitals, excluding physician, or professional fees. 4,9 Facility charges include, for example, room and board fees, and all other payments to hospitals. 10 Professional charges reflect services by physicians and other skilled health care professionals licensed for independent practice, including many clinicians treating patients in hospitals.…”

mentioning

confidence: 99%

Professional Fee Ratios for US Hospital Discharge Data

Peterson

Florence

et al. 2015

Medical Care

View full text Add to dashboard Cite

Background US hospital discharge datasets typically report facility charges (ie, room and board), excluding professional fees (ie, attending physicians’ charges). Objectives We aimed to estimate professional fee ratios (PFR) by year and clinical diagnosis for use in cost analyses based on hospital discharge data. Subjects The subjects consisted of a retrospective cohort of Truven Health MarketScan 2004–2012 inpatient admissions (n = 23,594,605) and treat-and-release emergency department (ED) visits (n = 70,771,576). Measures PFR per visit was assessed as total payments divided by facility-only payments. Research Design Using ordinary least squares regression models controlling for selected characteristics (ie, patient age, comorbidities, etc.), we calculated adjusted mean PFR for admissions by health insurance type (commercial or Medicaid) per year overall and by Major Diagnostic Category (MDC), Diagnostic Related Group, Healthcare Cost and Utilization Project Clinical Classification Software, and primary International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis, and for ED visits per year overall and by MDC and primary ICD-9-CM diagnosis. Results Adjusted mean PFR for 2012 admissions, including preceding ED visits, was 1.264 (95% CI, 1.264, 1.265) for commercially insured admissions (n = 2,614,326) and 1.177 (1.176, 1.177) for Medicaid admissions (n = 816,503), indicating professional payments increased total per-admission payments by an average 26.4% and 17.7%, respectively, above facility-only payments. Adjusted mean PFR for 2012 ED visits was 1.286 (1.286, 1.286) for commercially insured visits (n = 8,808,734) and 1.440 (1.439, 1.440) for Medicaid visits (n = 2,994,696). Supplemental tables report 2004–2012 annual PFR estimates by clinical classifications. Conclusions Adjustments for professional fees are recommended when hospital facility-only financial data from US hospital discharge datasets are used to estimate health care costs.

show abstract

mentioning

confidence: 99%

Professional Fee Ratios for US Hospital Discharge Data

Peterson

Florence

et al. 2015

Medical Care

View full text Add to dashboard Cite

show abstract

“…Episode-of-care payment models encourage such efficiency by providing healthcare systems with one lump-sum payment for a group of services required for a circumscribed diagnosis or procedure [9,27]. Elective primary TKA frequently is cited as an archetype of a procedure amenable to bundled payment [13].…”

Section: Discussionmentioning

confidence: 99%

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

Cram

Ravi

Vaughan-Sarrazin

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Episode-of-care payments are defined as a single lump-sum payment for all services associated with a single medical event or surgery and are designed to incentivize efficiency and integration among providers and healthcare systems. A TKA is considered an exemplar for an episode-of-care payment model by many policymakers, but data describing variation payments between hospitals for TKA are extremely limited. Questions/purposes We asked: (1) How much variation is there between hospitals in episode-of-care payments for primary TKA? (2) Is variation in payment explained by differences in hospital structural characteristics such as teaching status or geographic location, patient factors (age, sex, ethnicity, comorbidities), and discharge disposition during the postoperative period (home versus skilled nursing facility)? (3) After accounting for those factors, what proportion of the observed variation remains unexplained? Methods We used Medicare administrative data to identify fee-for-service beneficiaries who underwent a primary elective TKA in 2009. After excluding low-volume hospitals, we created longitudinal records for all patients undergoing TKAs in eligible hospitals encompassing virtually all payments by Medicare for a 120-day window around the TKA (30 days before to 90 days after). We examined payments for the preoperative, perioperative, and postdischarge periods based on the hospital where the TKA was performed. Confounding variables were controlled for using multivariate analyses to determine whetherThe institution of one of the authors (PC) has received, during the study period, funding from the National Institutes of Health (K24 AR062133 and R01 AG033035). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that the institutional review board at the University of Iowa approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the University of Iowa, Iowa City, IA. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® differences in hospital payments could be explained by differences in patient demographics, comorbidity, or hospital structural factors. Results There was considerable variation in payments across hospitals. Median (interquartile range) hospital preoperative, perioperative, postdischarge, and 120-day payments for patients who did not experience a complication were USD 623 (USD 516-768), USD 13,119 (USD 12,668), USD 8020 (USD 6403-9933), and USD 21,870 (USD 19,041), respectively. Variation cannot be explained by differences in hospital structure. Median (interquartile range) episode payments were greater for hospitals in the Northeast (USD 26,291 [22,323

show abstract

“…Certain payment models, such as ACOs, may help catalyze specific solutions to these problems by creating incentives for better coordination at the organizational level (eg, hospitals, skilled nursing facilities, and clinics), but these incentives may not necessarily translate into changes in physician practice, particularly as physicians payments are not yet part of bundled hospital care payments . Likewise, innovative practice models such as the PCMH have promise to reshape the way healthcare is delivered, particularly by fortifying the role of primary care providers; but again, we note the lack of specific guidance for providers, particularly hospitalists.…”

Section: Effects Of the Problem In Practice—variations In Physician Ementioning

confidence: 98%

Solving the puzzle of posthospital recovery: What is the role of the individual physician?

Greysen

Detsky

2015

Journal of Hospital Medicine

View full text Add to dashboard Cite

Improving transitions of care from the acute care setting has been an important focus of health policy in the United States and Canada. Over the past decade, hospital performance metrics related to successful recovery have been used in the United States to implement incentives for reform. This focus has led to a laudable number of interventions to reduce readmissions—a proxy for failed recovery—but most of these have focused on the hospital or system level rather than the individual physician level. Individual physicians in both the inpatient and outpatient setting have important roles to play, but little guidance or structured support is available to them to enable successful engagement in postdischarge management of patient transitions. We describe several tensions of physician engagement in this process from the perspective of front‐line providers and highlight several possible approaches to improve physician engagement in transitions. Journal of Hospital Medicine 2015;10:697–700. © 2015 Society of Hospital Medicine

show abstract

Including Physicians in Bundled Hospital Care Payments

Cited by 24 publications

References 6 publications

Professional Fee Ratios for US Hospital Discharge Data

Professional Fee Ratios for US Hospital Discharge Data

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

Solving the puzzle of posthospital recovery: What is the role of the individual physician?

Contact Info

Product

Resources

About