The New England Journal of Medicine Article Circulation and Review Board

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

BrotherOfMario

Full Member
10+ Year Member
Joined
Aug 16, 2011
Messages
21
Reaction score
0
copywrite

Members don't see this ad.
 
Last edited:
Opportunities and Challenges for Episode-Based Payment

NEJM | August 24, 2011 | Topics: Cost of Health Care, Health Care Delivery
Robert E. Mechanic, M.B.A.
Episode-based payment — in which reimbursement for medical services delivered during defined episodes of care is bundled together — is one of several payment reforms contained in the Affordable Care Act (ACA). Episodes cover a specified period that ranges from a few days to a year, during which patients may receive care from multiple providers. Is it possible to anticipate the health outcome and possible costs to fall within said 30-day post-discharge period?
PHP:
The objective is to create incentives for efficiency and better care coordination.
But episode-based payment is much more complex to administer than fee for service or capitation and thus faces substantial implementation challenges.
In 1991, the Centers for Medicare and Medicaid Services (CMS) began an episode-based–payment experiment for coronary bypass surgery that bundled payments for Medicare Part A and Part B services during admissions, plus readmissions within 72 hours. Although this approach reduced Medicare spending and improved quality in the seven participating hospitals, the demonstration wasn’t expanded because of hospital-industry opposition. Nearly a decade later, CMS began its acute care episode (ACE) demonstration, bundling Part A and Part B payments for 29 cardiac and orthopedic DRGs — but only five hospital systems currently participate. Medicare’s episode-based–payment initiatives will soon expand significantly, thanks to the ACA’s national pilot program that begins in 2013... (if we make it past 2012)
TBH, the formatting of this post makes it very difficult to understand...
 
Top