Bundled Payment Programs as an Application of Case Rate Provider Reimbursement

2020 ◽  
pp. 1-24
Author(s):  
Gregg M. Gascon ◽  
Gregory I. Sawchyn
Keyword(s):  
Bundled Payment ◽  
Case Rate

Decompensation placental dysfunction: diagnostics and delivery tactics

2017 ◽  
pp. 66-68
Author(s):  
V.I. Boyko ◽  
◽  
S.A. Tkachenko ◽  
Keyword(s):  
Pregnant Women ◽  
Key Words ◽  
Retrospective Analysis ◽  
Control Group ◽  
Present Stage ◽  
Placental Dysfunction ◽  
Perinatal Pathology ◽  
Delivery Times ◽  
Case Rate ◽  
Major Factors

The objective: depression of frequency of perinatal pathology at women with decompensation form of placental dysfunction by improvement of the main diagnostic and treatment-and-prophylactic actions. Patients and methods. 154 pregnant women in gestation term from 22 to 40 weeks were surveyed. Depending on features of course of pregnancy and families of all surveyed it was divided into 4 groups. The group of the retrospective analysis was made by 45 pregnant women with decompensation placental dysfuction, the group of prospective research included 109 pregnant women of whom the main group was made by 38 women with decompensation form of placental dysfunction, the group of comparison included 47 pregnant women with the compensated form of placental dysfunction. The control group was made by 24 pregnant women with the uncomplicated course of pregnancy and labors. The complex of the conducted researches included clinical, ehografical, dopplerometrical, laboratory, morphological and statistical methods. Results. Use of advanced algorithm of diagnostic and treatment-and-prophylactic actions allows to increase efficiency of diagnostics of decompensation form of placental dysfunction for 33.3%, and rational tactics of a delivery leads to depression of perinatal pathology for 22.7%. Conclusion. Decompensation placental dysfuction is one of the main reasons for perinatal mortality and a case rate at the present stage. Use of the algorithm of diagnostic and treatment-and-prophylactic actions improved by us allows major factors of risk of this complication and the indication for change of tactics and delivery times. Key words: decompensation placental dysfunction, diagnostics, delivery tactics.

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

2020 ◽  
Author(s):  
Sean S. Rajaee ◽  
Eytan M. Debbi ◽  
Guy D. Paiement ◽  
Andrew I. Spitzer
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Smoking Status ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
The United States ◽  
Bundled Payment ◽  
Vein Thrombosis ◽  
Total Knee ◽  
Payment Models

AbstractGiven a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were compared. There was a significant increase in the rate of smoking in TKA from 17.9% in 2012 to 19.2% in 2014 (p < 0.0001). The highest rate was seen in patients < 45 years of age (27.3%). Hospital resource usage was significantly higher for smokers, with a length of stay of 3.3 versus 2.9 days (p < 0.0001), and hospital costs of $16,752 versus $15,653 (p < 0.0001). A multivariable logistic model adjusting for age, gender, and comorbidities showed that smokers had an increased odds ratio for myocardial infarction (5.72), cardiac arrest (4.59), stroke (4.42), inpatient mortality (4.21), pneumonia (4.01), acute renal failure (2.95), deep vein thrombosis (2.74), urinary tract infection (2.43), transfusion (1.38) and sepsis (0.65) (all p < 0.0001). Smoking is common among patients undergoing elective TKA, and its prevalence continues to rise. Smoking is associated with higher hospital costs as well as higher rates of immediate inpatient complications. These findings are critical for risk stratification, improving of bundled payment models as well as patient education, and optimization prior to surgery to reduce costs and complications.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fanny Goude ◽  
Sverre A. C. Kittelsen ◽  
Henrik Malchau ◽  
Maziar Mohaddes ◽  
Clas Rehnberg
Keyword(s):  
Hip Replacement ◽  
Health Gain ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Economic Incentives ◽  
Bundled Payment ◽  
Treatment Groups ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Patient Reported

Abstract Background Competition-promoting reforms and economic incentives are increasingly being introduced worldwide to improve the performance of healthcare delivery. This study considers such a reform which was initiated in 2009 for elective hip replacement surgery in Stockholm, Sweden. The reform involved patient choice of provider, free establishment of new providers and a bundled payment model. The study aimed to examine its effects on hip replacement surgery quality as captured by patient reported outcome measures (PROMs) of health gain (as indicated by the EQ-5D index and a visual analogue scale (VAS)), pain reduction (VAS) and patient satisfaction (VAS) one and six years after the surgery. Methods Using patient-level data collected from multiple national registers, we applied a quasi-experimental research design. Data were collected for elective primary total hip replacements that were carried out between 2008 and 2012, and contain information on patient demography, the surgery and PROMs at baseline and at one- and six-years follow-up. In total, 36,627 observations were included in the analysis. First, entropy balancing was applied in order to reduce differences in observable characteristics between treatment groups. Second, difference-in-difference analyses were conducted to eliminate unobserved time-invariant differences between treatment groups and to estimate the causal treatment effects. Results The entropy balancing was successful in creating balance in all covariates between treatment groups. No significant effects of the reform were found on any of the included PROMs at one- and six-years follow-up. The sensitivity analyses showed that the results were robust. Conclusions Competition and bundled payment had no effects on the quality of hip replacement surgery as captured by post-surgery PROMs of health gain, pain reduction and patient satisfaction. The study provides important insights to the limited knowledge on the effects of competition and economic incentives on PROMs.

scholarly journals Dietary Behaviors and Incident COVID-19 in the UK Biobank

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2114
Author(s):  
Thanh-Huyen T. Vu ◽  
Kelsey J. Rydland ◽  
Chad J. Achenbach ◽  
Linda Van Horn ◽  
Marilyn C. Cornelis
Keyword(s):  
Dietary Behaviors ◽  
Processed Meat ◽  
Uk Biobank ◽  
Processed Meats ◽  
Additional Tool ◽  
Oily Fish ◽  
Case Rate ◽  
Specific Association ◽  
Socio Demographic Factors ◽  
The Uk

Background: Nutritional status influences immunity but its specific association with susceptibility to COVID-19 remains unclear. We examined the association of specific dietary data and incident COVID-19 in the UK Biobank (UKB). Methods: We considered UKB participants in England with self-reported baseline (2006–2010) data and linked them to Public Health England COVID-19 test results—performed on samples from combined nose/throat swabs, using real time polymerase chain reaction (RT-PCR)—between March and November 2020. Baseline diet factors included breastfed as baby and specific consumption of coffee, tea, oily fish, processed meat, red meat, fruit, and vegetables. Individual COVID-19 exposure was estimated using the UK’s average monthly positive case rate per specific geo-populations. Logistic regression estimated the odds of COVID-19 positivity by diet status adjusting for baseline socio-demographic factors, medical history, and other lifestyle factors. Another model was further adjusted for COVID-19 exposure. Results: Eligible UKB participants (n = 37,988) were 40 to 70 years of age at baseline; 17% tested positive for COVID-19 by SAR-CoV-2 PCR. After multivariable adjustment, the odds (95% CI) of COVID-19 positivity was 0.90 (0.83, 0.96) when consuming 2–3 cups of coffee/day (vs. <1 cup/day), 0.88 (0.80, 0.98) when consuming vegetables in the third quartile of servings/day (vs. lowest quartile), 1.14 (1.01, 1.29) when consuming fourth quartile servings of processed meats (vs. lowest quartile), and 0.91 (0.85, 0.98) when having been breastfed (vs not breastfed). Associations were attenuated when further adjusted for COVID-19 exposure, but patterns of associations remained. Conclusions: In the UK Biobank, consumption of coffee, vegetables, and being breastfed as a baby were favorably associated with incident COVID-19; intake of processed meat was adversely associated. Although these findings warrant independent confirmation, adherence to certain dietary behaviors may be an additional tool to existing COVID-19 protection guidelines to limit the spread of this virus.

scholarly journals Real-Time Identification of Patients Included in the CMS Bundled Payment Care Improvement (BPCI) Program

2020 ◽  
Vol 41 (S1) ◽  
pp. s367-s368
Author(s):  
Michael Korvink ◽  
John Martin ◽  
Michael Long
Keyword(s):  
Performance Evaluation ◽  
Real Time ◽  
Naive Bayes ◽  
Naïve Bayes ◽  
Care Providers ◽  
Meta Model ◽  
Bundled Payment ◽  
Clinical Cohort ◽  
Real Time Identification ◽  
Care Improvement

Background: The Bundled Payment Care Improvement Program is a CMS initiative designed to encourage greater collaboration across settings of care, especially as it relates to an initial set of targeted clinical episodes, which include sepsis and pneumonia. As with many CMS incentive programs, performance evaluation is retrospective in nature, resulting in after-the-fact changes in operational processes to improve both efficiency and quality. Although retrospective performance evaluation is informative, care providers would ideally identify a patient’s potential clinical cohort during the index stay and implement care management procedures as necessary to prevent or reduce the severity of the condition. The primary challenges for real-time identification of a patient’s clinical cohort are CMS-targeted cohorts are based on either MS-DRG (grouping of ICD-10 codes) or HCPCS coding—coding that occurs after discharge by clinical abstractors. Additionally, many informative data elements in the EHR lack standardization and no simple and reliable heuristic rules can be employed to meaningfully identify those cohorts without human review. Objective: To share the results of an ensemble statistical model to predict patient risks of sepsis and pneumonia during their hospital (ie, index) stay. Methods: The predictive model uses a combination of Bernoulli Naïve Bayes natural language processing (NLP) classifiers, to reduce text dimensionality into a single probability value, and an eXtreme Gradient Boosting (XGBoost) algorithm as a meta-model to collectively evaluate both standardized clinical elements alongside the NLP-based text probabilities. Results: Bernoulli Naïve Bayes classifiers have proven to perform well on short text strings and allow for highly explanatory unstructured or semistructured text fields (eg, reason for visit, culture results), to be used in a both comparative and generalizable way within the larger XGBoost model. Conclusions: The choice of XGBoost as the meta-model has the benefits of mitigating concerns of nonlinearity among clinical features, reducing potential of overfitting, while allowing missing values to exist within the data. Both the Bayesian classifier and meta-model were trained using a patient-level integrated dataset extracted from both a patient-billing and EHR data warehouse maintained by Premier. The data set, joined by patient admission-date, medical record number, date of birth, and hospital entity code, allows the presence of both the coded clinical cohort (derived from the MS-DRG) and the explanatory features in the EHR to exist within a single patient encounter record. The resulting model produced F1 performance scores of .65 for the sepsis population and .61 for the pneumonia population.Funding: NoneDisclosures: None

Providing Inpatient Mobilization with a Mobility Technician Constrains Cost in Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Thomas A. Novack ◽  
Christopher J. Mazzei ◽  
Jay N. Patel ◽  
Eileen B. Poletick ◽  
Roberta D'Achille ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Care Pathway ◽  
Primary Total Knee Arthroplasty ◽  
Cost Savings ◽  
Patient Discharge ◽  
Control Group ◽  
Study Group ◽  
Bundled Payment ◽  
Total Knee

AbstractSince the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.

scholarly journals As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jonas Wohlin ◽  
Clara Fischer ◽  
Karin Solberg Carlsson ◽  
Sara Korlén ◽  
Pamela Mazzocato ◽  
...  
Keyword(s):  
Cost Control ◽  
Care Quality ◽  
Patient Choice ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Publicly Funded ◽  
Public And Private ◽  
Bundled Payment ◽  
Private Providers ◽  
Number Of Patients

Abstract Background New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the appropriateness of a private sector-mimicking governance model in a public service. One voice in the debate suggested that rather than discussing whether competition is “good” or “bad” the emphasis should be on exploring the conditions for a successful implementation. Methods We report a longitudinal case study of the introduction of patient choice and allowing private providers to enter a publicly funded market. Patients in need of hip or knee replacement surgery are allowed to choose provider, and those are paid a fixed reimbursement for the full care episode (bundled payment). Providers are financially accountable for complications. Data on number of patients, waiting lists and times, costs to the public purchaser, and complications were collected from public registries. Providers were interviewed at three points in time during a nine-year follow-up period. Time-series of the quantitative data were exhibited and the views of actors involved were explored in a thematic analysis of the interviews. Results The policy goals of improving access to care and care quality while controlling total costs were achieved in a sustained way. Six themes were identified among actors interviewed and those were consistent over time. The design of the patient choice model was accepted, although all providers were discontent with the level of reimbursement. Providers felt that quality, timeliness of service and staff satisfaction had improved. Public and private providers differed in terms of patient-mix and developed different strategies to adjust to the reimbursement system. Private providers were more active in marketing and improving operation room efficiency. All providers intensified cooperation with referring physicians. Close attention was paid to following the rules set by the purchaser. Discussion and conclusions The sustained cost control was an effect of bundled payment. What this study shows is that both public and private providers adhere long-term to regulations by a public purchaser that also controls entrance to the market. The compensation was fixed and led to competition on quality, as predicted by theory.

Improving target price calculations in Medicare bundled payment programs

2021 ◽  
Author(s):  
Benjamin A. Y. Cher ◽  
Baris Gulseren ◽  
Andrew M. Ryan
Keyword(s):  
Target Price ◽  
Bundled Payment

scholarly journals Potential Influence of Menstrual Status and Sex Hormones on Female Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Cross-sectional Multicenter Study in Wuhan, China

2020 ◽  
Author(s):  
Ting Ding ◽  
Jinjin Zhang ◽  
Tian Wang ◽  
Pengfei Cui ◽  
Zhe Chen ◽  
...  
Keyword(s):  
Severe Case ◽  
Potential Influence ◽  
Necrosis Factor Alpha ◽  
Cross Sectional ◽  
Female Patients ◽  
Menstrual Status ◽  
Case Rate ◽  
Factor Alpha ◽  
Lower Morbidity ◽  
Necrosis Factor

Abstract Background Recent studies have indicated that females with coronavirus disease 2019 (COVID-19) have a lower morbidity, severe case rate, and mortality and better outcome than those of male individuals. However, the reasons remained to be addressed. Methods To find the factors that potentially protect females from COVID-19, we recruited all confirmed patients hospitalized at 3 branches of Tongji Hospital (N = 1902), and analyzed the correlation between menstrual status (n = 509, including 68 from Mobile Cabin Hospital), female hormones (n = 78), and cytokines related to immunity and inflammation (n = 263), and the severity/clinical outcomes in female patients &lt;60 years of age. Results Nonmenopausal female patients had milder severity and better outcome compared with age-matched men (P &lt; .01 for both). Menopausal patients had longer hospitalization times than nonmenopausal patients (hazard ratio [HR], 1.91 [95% confidence interval {CI}, 1.06–3.46]; P = .033). Both anti-Müllerian hormone (AMH) and estradiol (E2) showed a negative correlation with severity of infection (adjusted HR, 0.146 [95% CI, .026–.824], P = .029 and 0.304 [95% CI, .092–1.001], P = .05, respectively). E2 levels were negatively correlated with interleukin (IL) 2R, IL-6, IL-8, and tumor necrosis factor alpha in the luteal phase (P = .033, P = .048, P = .054, and P = .023) and C3 in the follicular phase (P = .030). Conclusions Menopause is an independent risk factor for female COVID-19 patients. AMH and E2 are potential protective factors, negatively correlated with COVID-19 severity, among which E2 is attributed to its regulation of cytokines related to immunity and inflammation.

Developing National Genotype-Independent Indicators for Recent Mycobacterium Tuberculosis Transmission Using Pediatric Cases—United States, 2011-2017

2021 ◽  
pp. 003335492098521
Author(s):  
Alexia V. Harrist ◽  
Clinton J. McDaniel ◽  
Jonathan M. Wortham ◽  
Sandy P. Althomsons
Keyword(s):  
United States ◽  
Mycobacterium Tuberculosis ◽  
Statistical Model ◽  
Moving Average ◽  
The United States ◽  
Tuberculosis Transmission ◽  
Average Proportion ◽  
Pediatric Tb ◽  
Case Rate ◽  
Pediatric Tuberculosis

Introduction Pediatric tuberculosis (TB) cases are sentinel events for Mycobacterium tuberculosis transmission in communities because children, by definition, must have been infected relatively recently. However, these events are not consistently identified by genotype-dependent surveillance alerting methods because many pediatric TB cases are not culture-positive, a prerequisite for genotyping. Methods We developed 3 potential indicators of ongoing TB transmission based on identifying counties in the United States with relatively high pediatric (aged <15 years) TB incidence: (1) a case proportion indicator: an above-average proportion of pediatric TB cases among all TB cases; (2) a case rate indicator: an above-average pediatric TB case rate; and (3) a statistical model indicator: a statistical model based on a significant increase in pediatric TB cases from the previous 8-quarter moving average. Results Of the 249 US counties reporting ≥2 pediatric TB cases during 2009-2017, 240 and 249 counties were identified by the case proportion and case rate indicators, respectively. The statistical model indicator identified 40 counties with a significant increase in the number of pediatric TB cases. We compared results from the 3 indicators with an independently generated list of 91 likely transmission events involving ≥2 pediatric cases (ie, known TB outbreaks or case clusters with reported epidemiologic links). All counties with likely transmission events involving multiple pediatric cases were identified by ≥1 indicator; 23 were identified by all 3 indicators. Practice Implications This retrospective analysis demonstrates the feasibility of using routine TB surveillance data to identify counties where ongoing TB transmission might be occurring, even in the absence of available genotyping data.

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