Medicare's Step Back from Global Payments — Unbundling Postoperative Care

Mulcahy, Andrew W.; Wynn, Barbara O.; Burgette, Lane F.; Mehrotra, Ateev

doi:10.1056/nejmp1415483

Cited by 13 publications

(10 citation statements)

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“…Historically, CMS has not collected data on how many post-operative visits are actually performed. Because post-operative visits make up about 22 percent of the total work of surgical global bundles (Mulcahy et al, 2015), inaccurate counts of post-operative visits may result in over-or underpayment on average to practitioners for specific procedures with global periods. Prior medical chart reviews by the Department of Health and Human Services (HHS) Office of Inspector General indicated that the number of post-operative visits used for valuation overestimates the number of post-operative visits actually provided in clinical practice for select surgical procedures with global periods (HHS, 2007(HHS, , 2012a(HHS, , 2012b.…”

Section: Introductionmentioning

confidence: 99%

Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods: Final Report

Gidengil¹,

Mulcahy²,

Mehrotra³

et al. 2019

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Section: Introductionmentioning

confidence: 99%

Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods: Final Report

Gidengil¹,

Mulcahy²,

Mehrotra³

et al. 2019

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“…32 A reform of health care funding is required for substantive workforce reconfiguration. 32,[54][55][56][57][58][59][60][61][62][63][64][65]…”

Section: Other Limits To This Analysismentioning

confidence: 99%

Matching the production of doctors with national needs

Gorman

2017

Med Educ

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Context Matching the supply of health workers to need is necessary if a health system is to be sustainable, affordable and fit for purpose. On the 30th anniversary of the 1988 Edinburgh Declaration of the World Federation for Medical Education, levels of compliance with the 10th recommendation, ‘Ensure admission policies that match the numbers of students trained with national needs for doctors’, warrant review. There are two domains to such a review, concerning, respectively, how well these health needs are known, and whether workforce supply is well matched. Methods This is a literature review‐based analysis of extant health system planning, which underpins current understanding of national health needs and of the consequent alignment of student selection processes. Results The core finding is that national need for doctors, and any other health workers, is not confidently known for any jurisdiction. Consequently, validation of student selection processes is impossible against this endpoint and data to validate these processes against the alternative endpoint of a positive impact on health outcomes do not exist. Data do exist to suggest some student selection processes result in desirable career and career location uptakes.

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“…Pay‐for‐performance schema also have a poor track record in the US, perhaps because they are not generally based on sound behavioural economics principles . Although there has been a shift of doctors into salaried practice, and variable degrees of bundling payments, much of the healthcare in the US is still purchased by way of paying for transactions. The extraordinary cost of healthcare in the US, in comparison to determined quality, is well recognised and has led to: the American College of Physicians requiring in their ethics manual that physicians be parsimonious in regard to using healthcare resources; the Department of Health and Human Services revising the payment goals for Medicare and Medicaid; calls for funding that promotes quality healthcare and valuable outcomes and an effective balance between coordination and competition; support for incentivising health practices that reduce readmissions and the National Commission on Physician Payment Reform has suggested the phasing out of fee‐for‐service payments altogether .…”

Section: Twelve Lessons About Purchasing High Quality Healthcare Thatmentioning

confidence: 99%