Single Institution Early Experience with the Bundled Payments for Care Improvement Initiative

R. Iorio, J. Bosco, J. Slover, Yousuf Sayeed, J. Zuckerman
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引用次数: 62

Abstract

Abstract: The Centers for Medicare & Medicaid Services (CMS) implemented the Bundled Payments for Care Improvement (BPCI) initiative in 2011. Through BPCI, organizations enlisted into payment agreements that include both performance and financial accountability for episodes of care. To succeed, BPCI requires quality maintenance and care delivery at lower costs. This necessitates physicians and hospitals to merge interests. Orthopaedic surgeons must assume leadership roles in cost containment, surgical safety, and quality assurance to deliver cost-effective care. Because most orthopaedic surgeons practice independently and are not employed by hospitals, models of physician-hospital alignment (e.g., physician-hospital organizations) or contracted gainsharing arrangements between practices and hospitals may be necessary for successful bundled pricing. Under BPCI, hospitals, surgeons, or third parties share rewards but assume risks for the bundle. For patients, cost savings must be associated with maintenance or improvement in quality metrics. However, the definition of quality can vary, as can the rewards for processes and outcomes. Risk stratification for potential complications should be considered in bundled pricing agreements to prevent the exclusion of patients with substantial comorbidities and higher care costs (e.g., hip fractures treated with prostheses). Bundled pricing depends on economies of scale for success; smaller institutions must be cautious, as 1 costly patient could substantially impact the finances of its entire program. CMS recommends a minimum of 100 to 200 cases yearly. We also suggest that participants utilize technologies to maximize efficiency and provide the best possible environment for implementation of bundled payments. Substantial investment in infrastructure is required to develop programs to improve coordination of care, manage quality data, and distribute payments. Smaller institutions may have difficulty devoting resources to these infrastructural changes, although changes may be implemented more thoroughly once initiated. Herein, we discuss our early total joint arthroplasty BPCI experience at our tertiary-care academic medical center.
单一机构早期护理改善计划捆绑付款的经验
摘要:美国联邦医疗保险和医疗补助服务中心(CMS)于2011年实施了护理改善捆绑支付(BPCI)计划。通过BPCI,组织被纳入支付协议,包括对护理事件的绩效和财务责任。为了取得成功,BPCI需要以较低的成本提供高质量的维护和护理。这就需要医生和医院合并利益。骨科医生必须在成本控制、手术安全和质量保证方面发挥领导作用,以提供具有成本效益的护理。由于大多数骨科医生独立执业,不受雇于医院,因此医师-医院联合模式(例如,医师-医院组织)或医师和医院之间的合同收益分享安排可能是成功捆绑定价的必要条件。在BPCI下,医院、外科医生或第三方分享奖励,但承担捆绑治疗的风险。对于患者而言,成本节约必须与质量指标的维持或改进相关联。然而,质量的定义可以变化,过程和结果的奖励也可以变化。在捆绑定价协议中应考虑潜在并发症的风险分层,以防止排除有严重合并症和较高护理费用的患者(例如,用假体治疗髋部骨折)。捆绑定价的成功取决于规模经济;较小的机构必须谨慎,因为一个昂贵的病人可能会严重影响整个项目的财务状况。CMS建议每年至少做100到200例。我们还建议与会各方利用技术手段实现效率最大化,并为实施捆绑支付提供最佳环境。需要对基础设施进行大量投资,以制定改善护理协调、管理高质量数据和分配支付的计划。较小的机构可能难以将资源用于这些基础设施改革,尽管改革一旦开始实施可能会更彻底。在此,我们讨论我们在三级保健学术医疗中心的早期全关节置换术BPCI经验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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