RESUMEN
BACKGROUND: Estimating a population-level benchmark rate for use of surgery in the management of cancer helps to identify treatment gaps, estimate the survival impact of such gaps, and benchmark the workforce and other resources, including budgets, required to meet service needs. A population-based benchmark for use of surgery in high-income settings to inform policy makers and service provision has not been developed but was recommended by the Lancet Oncology Commission on Global Cancer Surgery. We aimed to develop and validate a cancer surgery benchmarking model. METHODS: We examined the latest clinical guidelines from high-income countries (Australia, the UK, the EU, the USA, and Canada) and mapped surgical treatment pathways for 30 malignant cancer sites (19 individual sites and 11 grouped as other cancers) that were notifiable in Australia in 2014, broadly reflecting contemporary high-income models of care. The optimal use of surgery was considered as an indication for surgery where surgery is the treatment of choice for a given clinical scenario. Population-based epidemiological data, such as cancer stage, tumour characteristics, and fitness for surgery, were derived from Australia and other similar high-income settings for 2017. The probabilities across the clinical pathways of each cancer were multiplied and added together to estimate the population-level benchmark rates of cancer surgery, and further validated with the comparisons of observed rates of cancer surgery in the South Western Sydney Local Health District in 2006-12. Univariable and multivariable sensitivity analyses were done to explore uncertainty around model inputs, with mean (95% CI) benchmark surgery rates estimated on the basis of 10â000 Monte Carlo simulations. FINDINGS: Surgical treatment was indicated in 58% (95% CI 57-59) of newly diagnosed patients with cancer in Australia in 2014 at least once during the course of their treatment, but varied by site from 23% (17-27) for prostate cancer to 99% (96-99) for testicular cancer. Observed cancer surgery rates in South Western Sydney were comparable to the benchmarks for most cancers, but were higher for some cancers, such as prostate (absolute increase of 29%) and lower for others, such as lung (-14%). INTERPRETATION: The model provides a new template for high-income and emerging economies to rationally plan and assess their cancer surgery provision. There are differences in modelled versus observed surgery rates for some cancers, requiring more in-depth analysis of the observed differences. FUNDING: University of New South Wales Scientia Scholarship, UK Research and Innovation-Global Challenges Research Fund.
Asunto(s)
Países Desarrollados/economía , Neoplasias de Células Germinales y Embrionarias/economía , Neoplasias/economía , Neoplasias Testiculares/economía , Australia/epidemiología , Benchmarking/economía , Canadá/epidemiología , Manejo de Datos , Guías como Asunto/normas , Humanos , Neoplasias/epidemiología , Neoplasias/cirugía , Neoplasias de Células Germinales y Embrionarias/epidemiología , Neoplasias Testiculares/epidemiología , Reino Unido/epidemiologíaRESUMEN
In the merit-based incentive payment system (MIPS), quality measures are considered topped out if national median performance rates are ≥95%. Quality measures worth 10 points can be capped at 7 points if topped out for ≥2 years. This report compares the availability of diagnostic radiology (DR)-related and interventional radiology (IR)-related measures worth 10 points. A total of 196 MIPS clinical quality measures were reviewed on the Center for Medicare and Medicaid Services MIPS website. There are significantly more IR-related measures worth 10 points than DR measures (2/9 DR measures vs 9/12 IR measures; P = .03), demonstrating that clinical IR services can help mixed IR/DR groups maximize their Center for Medicare and Medicaid Services payment adjustment.
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Benchmarking/economía , Diagnóstico por Imagen/economía , Costos de la Atención en Salud , Indicadores de Calidad de la Atención de Salud/economía , Radiografía Intervencional/economía , Radiología Intervencionista/economía , Benchmarking/normas , Centers for Medicare and Medicaid Services, U.S./economía , Diagnóstico por Imagen/normas , Costos de la Atención en Salud/normas , Humanos , Planes de Incentivos para los Médicos/economía , Indicadores de Calidad de la Atención de Salud/normas , Radiografía Intervencional/normas , Radiología Intervencionista/normas , Reembolso de Incentivo/economía , Estados UnidosRESUMEN
The systematic use of evidence to inform healthcare decisions, particularly health technology assessment (HTA), has gained increased recognition. HTA has become a standard policy tool for informing decision makers who must manage the entry and use of pharmaceuticals, medical devices, and other technologies (including complex interventions) within health systems, for example, through reimbursement and pricing. Despite increasing attention to HTA activities, there has been no attempt to comprehensively synthesize good practices or emerging good practices to support population-based decision-making in recent years. After the identification of some good practices through the release of the ISPOR Guidelines Index in 2013, the ISPOR HTA Council identified a need to more thoroughly review existing guidance. The purpose of this effort was to create a basis for capacity building, education, and improved consistency in approaches to HTA-informed decision-making. Our findings suggest that although many good practices have been developed in areas of assessment and some other key aspects of defining HTA processes, there are also many areas where good practices are lacking. This includes good practices in defining the organizational aspects of HTA, the use of deliberative processes, and measuring the impact of HTA. The extent to which these good practices are used and applied by HTA bodies is beyond the scope of this report, but may be of interest to future researchers.
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Benchmarking/normas , Formulación de Políticas , Evaluación de la Tecnología Biomédica/normas , Benchmarking/economía , Benchmarking/métodos , Consenso , Medicina Basada en la Evidencia/normas , Humanos , Participación de los Interesados , Evaluación de la Tecnología Biomédica/economía , Evaluación de la Tecnología Biomédica/métodosRESUMEN
OBJECTIVE/BACKGROUND: There are few published data on the acute care or long-term costs after acute/critical limb or visceral ischaemia (ACLVI) events. Using data from patients with acute events in a population based incidence study (Oxford Vascular Study), the present study aimed to determine the long-term costs after an ACLVI event. METHODS: All patients with first ever incident ACLVI from 2002 to 2012 were included. Analysis was based on follow up until January 2017, with all patients having full 5 year follow up. Multivariate regressions were used to assess baseline and subsequent predictors of total 5 year hospital care costs. Overall costs after an ACLVI event were benchmarked against those after stroke in the same population, during the same period. RESULTS: Among 351 patients with an ACLVI event, mean 5 year total care costs were 35,211 (SD 50,500), of which 6443 (18%) were due to long-term institutionalisation. Costs differed by type of event (acute visceral ischaemia 16,476; acute limb ischaemia 24,437; critical limb ischaemia 46,281; p < 0.001). Results of the multivariate analyses showed that patients with diabetes and those undergoing above knee amputations incurred additional costs of 11,804 (p = 0.014) and 25,692 (p < 0.001), respectively. Five year hospital care costs after an ACLVI event were significantly higher than after stroke (28,768 vs. 22,623; p = 0.004), but similar after including long-term costs of institutionalisation (35,211 vs. 35,391; p = 0.957). CONCLUSION: Long-term care costs after an ACLVI event are considerable, especially after critical limb ischaemia. Hospital care costs were significantly higher than for stroke over the long term, and were similar after inclusion of costs of institutionalisation.
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Benchmarking/economía , Extremidades/irrigación sanguínea , Costos de Hospital , Institucionalización/economía , Isquemia/economía , Cuidados a Largo Plazo/economía , Enfermedad Arterial Periférica/economía , Evaluación de Procesos, Atención de Salud/economía , Accidente Cerebrovascular/economía , Vísceras/irrigación sanguínea , Anciano , Anciano de 80 o más Años , Inglaterra , Femenino , Humanos , Incidencia , Isquemia/diagnóstico , Isquemia/mortalidad , Isquemia/terapia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos Económicos , Análisis Multivariante , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/terapia , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To provide an update on the status of provider participation in the US Wound Registry (USWR) and its specialty registry the Hyperbaric Oxygen Therapy Registry (HBOTR), which provide much-needed national benchmarking and quality measurement services for hyperbaric medicine. METHODS: Providers can meet many requirements of the Merit-Based Incentive Payment System (MIPS) and simultaneously participate in the HBOTR by transmitting Continuity of Care Documents (CCDs) directly from their certified electronic health record (EHR) or by reporting hyperbaric quality measures, the specifications for which are available free of charge for download from the registry website as electronic clinical quality measures for installation into any certified EHR. Computerized systems parse the structured data transmitted to the USWR. Patients undergoing hyperbaric oxygen (HBO2) therapy are allocated to the HBOTR and stored in that specialty registry database. The data can be queried for benchmarking, quality reporting, public policy, or specialized data projects. RESULTS: Since January 2012, 917,758 clinic visits have captured the data of 199,158 patients in the USWR, 3,697 of whom underwent HBO2 therapy. Among 27,404 patients with 62,843 diabetic foot ulcers (DFUs) captured, 9,908 DFUs (15.7%) were treated with HBO2 therapy. Between January 2016 and September 2018, the benchmark rate for the 1,000 DFUs treated with HBO2 was 7.3%, with an average of 28 treatments per patient. There are 2,100 providers who report data to the USWR by transmitting CCDs from their EHR and 688 who submit quality measure data, 300 (43.6%) of whom transmit HBO2 quality data.
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Benchmarking , Pie Diabético/terapia , Adhesión a Directriz , Oxigenoterapia Hiperbárica/estadística & datos numéricos , Oxigenoterapia Hiperbárica/normas , Sistema de Registros/estadística & datos numéricos , American Recovery and Reinvestment Act , Amputación Quirúrgica , Benchmarking/economía , Glucemia/análisis , Centers for Medicare and Medicaid Services, U.S./legislación & jurisprudencia , Continuidad de la Atención al Paciente/estadística & datos numéricos , Pie Diabético/sangre , Registros Electrónicos de Salud/estadística & datos numéricos , Humanos , Evaluación Nutricional , Osteomielitis/terapia , Osteorradionecrosis/terapia , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad , Sistema de Registros/normas , Mecanismo de Reembolso , Resultado del Tratamiento , Estados Unidos , Procedimientos Innecesarios/estadística & datos numéricos , Cicatrización de HeridasRESUMEN
BACKGROUND: Fenestrated endovascular aneurysm repair (FEVAR) allows endovascular treatment of thoracoabdominal and juxtarenal aneurysms previously outside the indications of use for standard devices. However, because of considerable device costs and increased procedure time, FEVAR is thought to result in financial losses for medical centers and physicians. We hypothesized that surgeon leadership in the coding, billing, and contractual negotiations for FEVAR procedures will increase medical center contribution margin (CM) and physician reimbursement. METHODS: At the UMass Memorial Center for Complex Aortic Disease, a vascular surgeon with experience in medical finances is supported to manage the billing and coding of FEVAR procedures for medical center and physician reimbursement. A comprehensive financial analysis was performed for all FEVAR procedures (2011-2015), independent of insurance status, patient presentation, or type of device used. Medical center CM (actual reimbursement minus direct costs) was determined for each index FEVAR procedure and for all related subsequent procedures, inpatient or outpatient, 3 months before and 1 year subsequent to the index FEVAR procedure. Medical center CM for outpatient clinic visits, radiology examinations, vascular laboratory studies, and cardiology and pulmonary evaluations related to FEVAR were also determined. Surgeon reimbursement for index FEVAR procedure, related adjunct procedures, and assistant surgeon reimbursement were also calculated. All financial analyses were performed and adjudicated by the UMass Department of Finance. RESULTS: The index hospitalization for 63 FEVAR procedures incurred $2,776,726 of direct costs and generated $3,027,887 in reimbursement, resulting in a positive CM of $251,160. Subsequent related hospital procedures (n = 26) generated a CM of $144,473. Outpatient clinic visits, radiologic examinations, and vascular laboratory studies generated an additional CM of $96,888. Direct cost analysis revealed that grafts accounted for the largest proportion of costs (55%), followed by supplies (12%), bed (12%), and operating room (10%). Total medical center CM for all FEVAR services was $492,521. Average surgeon reimbursements per FEVAR from 2011 to 2015 increased from $1601 to $2480 while the surgeon payment denial rate declined from 50% to 0%. Surgeon-led negotiations with the Centers for Medicare & Medicaid Services during 2015 resulted in a 27% increase in physician reimbursement for the remainder of 2015 ($2480 vs $3068/case) and a 91% increase in reimbursement from 2011 ($1601 vs $3068). Assistant surgeon reimbursement also increased ($266 vs $764). Concomitant FEVAR-related procedures generated an additional $27,347 in surgeon reimbursement. CONCLUSIONS: Physician leadership in the coding, billing, and contractual negotiations for FEVAR results in a positive medical center CM and increased physician reimbursement.
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Aneurisma de la Aorta/economía , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/economía , Codificación Clínica , Contratos/economía , Procedimientos Endovasculares/economía , Planes de Aranceles por Servicios/economía , Costos de Hospital , Liderazgo , Negociación , Rol del Médico , Cirujanos/economía , Actitud del Personal de Salud , Benchmarking/economía , Implantación de Prótesis Vascular/clasificación , Propuestas de Licitación/economía , Análisis Costo-Beneficio , Bases de Datos Factuales , Procedimientos Endovasculares/clasificación , Planes de Aranceles por Servicios/clasificación , Gastos en Salud , Precios de Hospital , Humanos , Massachusetts , Evaluación de Procesos, Atención de Salud/clasificación , Evaluación de Procesos, Atención de Salud/economía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Although Accountable Care Organizations (ACOs) are defined by the provision of primary care services, the relationship between the intensity of primary care and population-level utilization and costs of health care services has not been examined during early implementation of Medicare Shared Savings Program (MSSP) ACOs. Our objective was to evaluate the association between primary care focus and healthcare utilization and spending in the first performance period of the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). METHODS: In this retrospective cohort study, we divided the 220 MSSP ACOs into quartiles of primary care focus based on the percentage of all ambulatory evaluation and management services delivered by a PCP (internist, family physician, or geriatrician). Using multivariable regression, we evaluated rates of utilization and spending during the initial performance period, adjusting for the percentage of non-white patients, region, number of months enrolled in the MSSP, number of beneficiary person years, percentage of dual eligible beneficiaries and percentage of beneficiaries over the age of 74. RESULTS: The proportion of ambulatory evaluation and management services delivered by a PCP ranged from <38% (lowest quartile, ACOs with least PCP focus) to >46% (highest quartile, ACOs with greatest PCP focus). ACOs in the highest quartile of PCP focus had higher adjusted rates of utilization of acute care hospital admissions (328 per 1000 person years vs 292 per 1000 person years, p = 0.01) and emergency department visits (756 vs 680 per 1000 person years, p = 0.02) compared with ACOs in the lowest quartile of PCP focus. ACOs in the highest quartile of PCP focus achieved no greater savings per beneficiary relative to their spending benchmarks ($142 above benchmark vs $87 below benchmark, p = 0.13). CONCLUSIONS: Primary care focus was not associated with increased savings or lower utilization of healthcare during the initial implementation of MSSP ACOs.
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Organizaciones Responsables por la Atención/economía , Medicare/economía , Atención Primaria de Salud/economía , Análisis de Varianza , Benchmarking/economía , Ahorro de Costo , Humanos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos , Estados UnidosRESUMEN
Under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in an Accountable Care Organization (ACO) continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. This final rule addresses changes to the Shared Savings Program, including: Modifications to the program's benchmarking methodology, when resetting (rebasing) the ACO's benchmark for a second or subsequent agreement period, to encourage ACOs' continued investment in care coordination and quality improvement; an alternative participation option to encourage ACOs to enter performance-based risk arrangements earlier in their participation under the program; and policies for reopening of payment determinations to make corrections after financial calculations have been performed and ACO shared savings and shared losses for a performance year have been determined.
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Organizaciones Responsables por la Atención/economía , Organizaciones Responsables por la Atención/legislación & jurisprudencia , Benchmarking/economía , Benchmarking/legislación & jurisprudencia , Ahorro de Costo/economía , Ahorro de Costo/legislación & jurisprudencia , Medicare/economía , Medicare/legislación & jurisprudencia , Planes de Aranceles por Servicios/economía , Planes de Aranceles por Servicios/legislación & jurisprudencia , Humanos , Garantía de la Calidad de Atención de Salud/economía , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Ajuste de Riesgo/economía , Ajuste de Riesgo/legislación & jurisprudencia , Estados UnidosRESUMEN
BACKGROUND: In several countries, health care policies gear toward strengthening the position of primary care physicians. Primary care physicians are increasingly expected to take accountability for overall spending and quality. Yet traditional models of paying physicians do not provide adequate incentives for taking on this new role. Under a so-called shared savings program physicians are instead incentivized to take accountability for spending and quality, as the program lets them share in cost savings when quality targets are met. We provide a structured approach to designing a shared savings program for primary care, and apply this approach to the design of a shared savings program for a Dutch chain of primary care providers, which is currently being piloted. METHODS: Based on the literature, we defined five building blocks of shared savings models that encompass the definition of the scope of the program, the calculation of health care expenditures, the construction of a savings benchmark, the assessment of savings and the rules and conditions under which savings are shared. We apply insights from a variety of literatures to assess the relative merits of alternative design choices within these building blocks. The shared savings program uses an econometric model of provider expenditures as an input to calculating a casemix-corrected benchmark. RESULTS: The minimization of risk and uncertainty for both payer and provider is pertinent to the design of a shared savings program. In that respect, the primary care setting provides a number of unique opportunities for achieving cost and quality targets. Accountability can more readily be assumed due to the relatively long-lasting relationships between primary care physicians and patients. A stable population furthermore improves the confidence with which savings can be attributed to changes in population management. Challenges arise from the institutional context. The Dutch health care system has a fragmented structure and providers are typically small in size. CONCLUSION: Shared savings programs fit the concept of enhanced primary care. Incorporating a shared savings program into existing payment models could therefore contribute to the financial sustainability of this organizational form.
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Ahorro de Costo/economía , Atención Primaria de Salud/economía , Benchmarking/economía , Atención a la Salud/economía , Reforma de la Atención de Salud/economía , Gastos en Salud , Personal de Salud/economía , Política de Salud/economía , Humanos , Países Bajos , Médicos de Atención Primaria/economía , Proyectos Piloto , Atención Primaria de Salud/organización & administración , Estudios Prospectivos , Medición de RiesgoAsunto(s)
Benchmarking , Control de Costos , Costos de la Atención en Salud , Benchmarking/economía , Benchmarking/legislación & jurisprudencia , Connecticut , Control de Costos/legislación & jurisprudencia , Control de Costos/métodos , Control de Costos/normas , Delaware , Costos de la Atención en Salud/legislación & jurisprudencia , Costos de la Atención en Salud/normas , Costos de la Atención en Salud/tendencias , Gastos en Salud/legislación & jurisprudencia , Humanos , Massachusetts , Oregon , Rhode Island , Estados UnidosRESUMEN
PURPOSE: Transparency of economic performance of integrated care systems (IV) is a basic requirement for the acceptance and further development of integrated care. Diverse evaluation methods are used but are seldom openly discussed because of the proprietary nature of the different business models. The aim of this article is to develop a generic model for measuring economic performance of IV interventions. METHODS: A catalogue of five quality criteria is used to discuss different evaluation methods -(uncontrolled before-after-studies, control group-based approaches, regression models). On this -basis a best practice model is proposed. RESULTS: A regression model based on the German morbidity-based risk structure equalisation scheme (MorbiRSA) has some benefits in comparison to the other methods mentioned. In particular it requires less resources to be implemented and offers advantages concerning the relia-bility and the transparency of the method (=important for acceptance). Also validity is sound. Although RCTs and - also to a lesser -extent - complex difference-in-difference matching approaches can lead to a higher validity of the results, their feasibility in real life settings is limited due to economic and practical reasons. That is why central criticisms of a MorbiRSA-based model were addressed, adaptions proposed and incorporated in a best practice model: Population-oriented morbidity adjusted margin improvement model (P-DBV(MRSA)). CONCLUSION: The P-DBV(MRSA) approach may be used as a standardised best practice model for the economic evaluation of IV. Parallel to the proposed approach for measuring economic performance a balanced, quality-oriented performance measurement system should be introduced. This should prevent incentivising IV-players to undertake short-term cost cutting at the expense of quality.
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Benchmarking/organización & administración , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/normas , Modelos Económicos , Evaluación de Resultado en la Atención de Salud/normas , Guías de Práctica Clínica como Asunto/normas , Benchmarking/economía , Análisis Costo-Beneficio/economía , Análisis Costo-Beneficio/normas , Alemania , Evaluación de Resultado en la Atención de Salud/economía , Ciencia/normasAsunto(s)
Benchmarking/economía , Medicare Access and CHIP Reauthorization Act of 2015/economía , Reportes Públicos de Datos en Atención de Salud , Indicadores de Calidad de la Atención de Salud/economía , Reembolso de Incentivo/economía , Procedimientos Quirúrgicos Vasculares/economía , Benchmarking/normas , Humanos , Medicare Access and CHIP Reauthorization Act of 2015/normas , Indicadores de Calidad de la Atención de Salud/normas , Reembolso de Incentivo/normas , Estados Unidos , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/normasRESUMEN
OBJECTIVE: Endovascular aneurysm repair (EVAR) is associated with significant direct device costs. Such costs place EVAR at odds with efforts to constrain healthcare expenditures. This study examines the procedure-associated costs and operating margins associated with EVAR at a tertiary care academic medical center. METHODS: All infrarenal EVARs performed from April 2011 to March 2012 were identified (n = 127). Among this cohort, 49 patients met standard commercial instruction for use guidelines, were treated using a single manufacturer device, and billed to Medicare diagnosis-related group (DRG) 238. Of these 49 patients, net technical operating margins (technical revenue minus technical cost) were calculated in conjunction with the hospital finance department. EVAR implant costs were determined for each procedure. DRG 238-associated costs and length of stay were benchmarked against other academic medical centers using University Health System Consortium 2012 data. RESULTS: Among the studied EVAR cohort (age 75, 82% male, mean length of stay, 1.7 days), mean technical costs totaled $31,672. Graft implants accounted for 52% of the allocated technical costs. Institutional overhead was 17% ($5495) of total technical costs. Net mean total technical EVAR-associated operating margins were -$4015 per procedure. Our institutional costs and length of stay, when benchmarked against comparable centers, remained in the lowest quartile nationally using University Health System Consortium costs for DRG 238. Stent graft price did not correlate with total EVAR market share. CONCLUSIONS: EVAR is currently associated with significant negative operating margins among Medicare beneficiaries. Currently, device costs account for over 50% of EVAR-associated technical costs and did not impact EVAR market share, reflecting an unawareness of cost differential among surgeons. These data indicate that EVAR must undergo dramatic care delivery redesign for this practice to remain sustainable.
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Aneurisma/economía , Aneurisma/cirugía , Implantación de Prótesis Vascular/economía , Procedimientos Endovasculares/economía , Gastos en Salud , Costos de Hospital , Centros Médicos Académicos/economía , Anciano , Benchmarking/economía , Prótesis Vascular/economía , Implantación de Prótesis Vascular/instrumentación , Control de Costos , Análisis Costo-Beneficio , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Tiempo de Internación/economía , Masculino , Medicare/economía , Centros de Atención Terciaria/economía , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
Imperfect efficiency in healthcare delivery is sometimes given as a justification for refusing to ration or even discuss how to pursue fair rationing. This paper aims to clarify the relationship between inefficiency and rationing, and the conditions under which bedside rationing can be justified despite coexisting inefficiency. This paper first clarifies several assumptions that underlie the classification of a clinical practice as being inefficient. We then suggest that rationing is difficult to justify in circumstances where the rationing agent is or should be aware of and contributes to clinical inefficiency. We further explain the different ethical implications of this suggestion for rationing decisions made by clinicians. We argue that rationing is more legitimate when sufficient efforts are undertaken to decrease inefficiency in parallel with efforts to pursue unavoidable but fair rationing. While the qualifier 'sufficient' is crucial here, we explain why 'sufficient efforts' should be translated into 'benchmarks of efficiency' that address specific healthcare activities where clinical inefficiency can be decreased. Referring to recent consensus papers, we consider some examples of specific clinical situations where improving clinical inefficiency has been recommended and consider how benchmarks for efficiency might apply. These benchmarks should state explicitly how much inefficiency shall be reduced in a reasonable time range and why these efforts are 'sufficient'. Possible strategies for adherence to benchmarks are offered to address the possibility of non-compliance.
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Benchmarking/ética , Atención a la Salud/ética , Eficiencia Organizacional/ética , Asignación de Recursos para la Atención de Salud/economía , Asignación de Recursos para la Atención de Salud/ética , Selección de Paciente/ética , Benchmarking/economía , Atención a la Salud/economía , Eficiencia Organizacional/economía , Eficiencia Organizacional/normas , Alemania , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/ética , Humanos , Responsabilidad SocialRESUMEN
OSF HealthCare's executive dashboard provides: A detailed view of top-level measures to frame OSF's mission and vision for all stakeholders. An easily understood, holistic snapshot of performance An assessment of relationships among system goals, initiatives, and results. Explicit understanding of the organization's priority performance measures and the extent to which they need to improve. A vehicle for transitioning to a value-based business model.
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Benchmarking/organización & administración , Cultura Organizacional , Benchmarking/economía , Ahorro de Costo , Instituciones de Salud , Illinois , Estudios de Casos Organizacionales , Administración de Personal en Hospitales , Estados UnidosRESUMEN
Operational prototyping is a disciplined approach to developing best practices that enable an organization to enhance value through improved quality of care and reduced costs. The aim of operational prototyping is to fine-tune performance to the level of best practices by considering every element involved in a care process, including the design of the facilities required to support the process. The broad goal of this approach is to be able to standardize and replicate the identified best practices in every location across a health system.
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Servicio Ambulatorio en Hospital/organización & administración , Garantía de la Calidad de Atención de Salud/organización & administración , Desarrollo de Personal/normas , Centros de Atención Terciaria/organización & administración , Benchmarking/economía , Benchmarking/métodos , Benchmarking/normas , Control de Costos/métodos , Eficiencia Organizacional/economía , Implementación de Plan de Salud/economía , Implementación de Plan de Salud/métodos , Implementación de Plan de Salud/organización & administración , Humanos , Modelos Organizacionales , Estudios de Casos Organizacionales , Innovación Organizacional , Servicio Ambulatorio en Hospital/normas , Servicio Ambulatorio en Hospital/tendencias , Desarrollo de Programa/economía , Desarrollo de Programa/métodos , Evaluación de Programas y Proyectos de Salud/economía , Evaluación de Programas y Proyectos de Salud/métodos , Garantía de la Calidad de Atención de Salud/economía , Garantía de la Calidad de Atención de Salud/métodos , Desarrollo de Personal/métodos , Centros de Atención Terciaria/normas , Centros de Atención Terciaria/tendencias , West VirginiaRESUMEN
Due to the rising costs and competitive pressures radiological clinics and practices are now facing, controlling instruments are gaining importance in the optimization of structures and processes of the various diagnostic examinations and interventional procedures. It will be shown how the use of selected controlling instruments can secure and improve the performance of radiological facilities. A definition of the concept of controlling will be provided. It will be shown which controlling instruments can be applied in radiological departments and practices. As an example, two of the controlling instruments, material cost analysis and benchmarking, will be illustrated.
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Benchmarking/economía , Benchmarking/métodos , Técnicas de Apoyo para la Decisión , Diagnóstico por Imagen/economía , Modelos Econométricos , Radiología/economía , Programas Informáticos , Control de Costos/economía , Control de Costos/métodos , AlemaniaRESUMEN
Monitoring the quality of dialysis care has long been a component of the Medicare ESRD program. As part of the 2008 Medicare Improvements for Patients and Providers Act (MIPPA), Congress mandated the Quality Incentive Program (QIP), which linked measures of care quality to payments. The legislation embraced the idea that this linkage of federal money to performance would encourage the purchase of greater 'value.' The first 2 program years for the QIP use a simple scoring methodology and a limited scope of quality metrics. For payment year 2014 (performance period calendar year 2012), the program changes substantially, with an expanded number of quality measures and a more complex scoring methodology. In this article, we describe the program structure, quality measures, scoring system, and financial impact.
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Centers for Medicare and Medicaid Services, U.S./economía , Atención a la Salud/economía , Fallo Renal Crónico/terapia , Evaluación de Procesos y Resultados en Atención de Salud/economía , Mejoramiento de la Calidad/economía , Indicadores de Calidad de la Atención de Salud/economía , Reembolso de Incentivo , Diálisis Renal/economía , Benchmarking/economía , Centers for Medicare and Medicaid Services, U.S./legislación & jurisprudencia , Centers for Medicare and Medicaid Services, U.S./normas , Atención a la Salud/legislación & jurisprudencia , Atención a la Salud/normas , Financiación Gubernamental , Regulación Gubernamental , Costos de la Atención en Salud , Política de Salud/economía , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/economía , Evaluación de Procesos y Resultados en Atención de Salud/legislación & jurisprudencia , Evaluación de Procesos y Resultados en Atención de Salud/normas , Guías de Práctica Clínica como Asunto , Desarrollo de Programa , Mejoramiento de la Calidad/legislación & jurisprudencia , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Indicadores de Calidad de la Atención de Salud/normas , Reembolso de Incentivo/legislación & jurisprudencia , Reembolso de Incentivo/normas , Diálisis Renal/normas , Resultado del Tratamiento , Estados UnidosRESUMEN
BACKGROUND: Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. RESEARCH DESIGN: Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected primary care activity levels (PCAL) and 9 patient outcomes for performance assessment. We evaluated models using 457,000 people assigned to 436 primary care physician panels, and among 13,000 people in a distinct multipayer medical home implementation with commercially insured, Medicare, and Medicaid patients. METHODS: Each outcome is separately predicted from age, sex, and diagnoses. We define the PCAL outcome as a subset of all costs that proxies the bundled payment needed for comprehensive primary care. Other expected outcomes are used to establish targets against which actual performance can be fairly judged. We evaluate model performance using R(2)'s at patient and practice levels, and within policy-relevant subgroups. RESULTS: The PCAL model explains 67% of variation in its outcome, performing well across diverse patient ages, payers, plan types, and provider specialties; it explains 72% of practice-level variation. In 9 performance measures, the outcome-specific models explain 17%-86% of variation at the practice level, often substantially outperforming a generic score like the one used for full capitation payments in Medicare: for example, with grouped R(2)'s of 47% versus 5% for predicting "prescriptions for antibiotics of concern." CONCLUSIONS: Existing data can support the risk-adjusted bundled payment calculations and performance assessments needed to encourage desired transformations in primary care.