Assuntos
Atenção à Saúde/organização & administração , Eficiência Organizacional , Seguro Saúde/organização & administração , Atenção à Saúde/economia , Atenção à Saúde/normas , Governo Federal , Custos de Cuidados de Saúde , Seguro Saúde/normas , Medicare/normas , Patient Protection and Affordable Care Act , Estados UnidosAssuntos
Instituições Associadas de Saúde , Hospitais , Encaminhamento e Consulta/organização & administração , Competição Econômica , Economia Hospitalar , Regulamentação Governamental , Instituições Associadas de Saúde/legislação & jurisprudência , Administração Hospitalar , Encaminhamento e Consulta/legislação & jurisprudência , Estados UnidosRESUMO
The onset and timing of the growth of children and adolescents occurs with considerable variability in cohorts of the same chronological age. The musculoskeletal system changes in proportion over time, and lever-arm changes, altered individual flexibility, and strength lead to age-specific injury patterns in youth sports. In sports, juniors are commonly grouped according to their chronological age. Early- and late-maturing children and adolescents might therefore not routinely be trained in relation to their biology. This not only represents a risk for overuse and injury but might limit their development in sports. To obtain information about the biological age of children is challenging. Numerous methods have been studied and validated. However, the implementation of these methods on a large scale is still to come. This report provides a brief overview of growth dynamics in relation to youth sports injuries and describes a few challenges for the future.
Assuntos
Traumatismos em Atletas/fisiopatologia , Desenvolvimento Infantil , Transtornos Traumáticos Cumulativos/fisiopatologia , Adolescente , Traumatismos em Atletas/prevenção & controle , Densidade Óssea/fisiologia , Cartilagem/fisiologia , Criança , Transtornos Traumáticos Cumulativos/prevenção & controle , Humanos , Educação Física e Treinamento , Fatores de RiscoRESUMO
IMPORTANCE: Recent governmental and private initiatives have sought to reduce health care costs by making health care prices more transparent. OBJECTIVE: To determine whether the use of an employer-sponsored private price transparency platform was associated with lower claims payments for 3 common medical services. DESIGN: Payments for clinical services provided were compared between patients who searched a pricing website before using the service with patients who had not researched prior to receiving this service. Multivariable generalized linear model regressions with propensity score adjustment controlled for demographic, geographic, and procedure differences. To test for selection bias, payments for individuals who used the platform to search for services (searchers) were compared with those who did not use the platform to search for services (nonsearchers) in the period before the platform was available. The exposure was the use of the price transparency platform to search for laboratory tests, advanced imaging services, or clinician office visits before receiving care for that service. SETTING AND PARTICIPANTS: Medical claims from 2010-2013 of 502,949 patients who were insured in the United States by 18 employers who provided a price transparency platform to their employees. MAIN OUTCOMES AND MEASURES: The primary outcome was total claims payments (the sum of employer and employee spending for each claim) for laboratory tests, advanced imaging services, and clinician office visits. RESULTS: Following access to the platform, 5.9% of 2,988,663 laboratory test claims, 6.9% of 76,768 advanced imaging claims, and 26.8% of 2,653,227 clinician office visit claims were associated with a prior search on the price transparency platform. Before having access to the price transparency platform, searchers had higher claims payments than nonsearchers for laboratory tests (4.11%; 95% CI, 1.87%-6.41%), higher payments for advanced imaging services (5.57%; 95% CI, 1.83%-9.44%), and no difference in payments for clinician office visits (0.26%; 95% CI; 0.53%-0.005%). Following access to the price transparency platform, relative claim payments for searchers were lower for searchers than nonsearchers by 13.93% (95% CI, 10.28%-17.43%) for laboratory tests, 13.15% (95% CI, 9.49%-16.66%) for advanced imaging, and 1.02% (95% CI, 0.57%-1.47%) for clinician office visits. The absolute payment differences were $3.45 (95% CI, $1.78-$5.12) for laboratory tests, $124.74 (95% CI, $83.06-$166.42) for advanced imaging services, and $1.18 (95% CI, $0.66-$1.70) for clinician office visits. CONCLUSIONS AND RELEVANCE: Use of price transparency information was associated with lower total claims payments for common medical services. The magnitude of the difference was largest for advanced imaging services and smallest for clinical office visits. Patient access to pricing information before obtaining clinical services may result in lower overall payments made for clinical care.
Assuntos
Acesso à Informação , Revelação , Custos de Cuidados de Saúde/normas , Reembolso de Seguro de Saúde/economia , Diagnóstico por Imagem/economia , Técnicas e Procedimentos Diagnósticos/economia , Serviços de Saúde/economia , Humanos , Revisão da Utilização de Seguros , Internet , Visita a Consultório Médico/economia , Estudos Retrospectivos , Estados UnidosRESUMO
The Affordable Care Act is a once-in-a-generation change to the U.S. health system. It guarantees access to health care for all Americans, creates new incentives to change clinical practice to foster better coordination and quality, gives physicians more information to make them better clinicians and patients more information to make them more value-conscious consumers, and changes the payment system to reward value. The Act and the health information technology provisions in the American Recovery and Reinvestment Act remove many barriers to delivering high-quality care, such as unnecessary administrative complexity, inaccessible clinical data, and insufficient access to primary care and allied health providers. We hope that physicians will embrace the opportunities created by the Affordable Care Act that will enable them to provide better care for their patients and lead the U.S. health system in a more positive direction. To fully realize the benefits of the Affordable Care Act for their practices and their patients, physicians will design their offices for seamless care, employing new practice models and using technology to integrate patient information with professional society guidelines to keep patients with chronic conditions healthy and out of the hospital. Under the Affordable Care Act, physicians who effectively collaborate with other providers to improve patient outcomes, the value of medical services, and patient experiences will thrive and be the leaders of the health care system.
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American Recovery and Reinvestment Act , Medicina Clínica/tendências , Reforma dos Serviços de Saúde/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Medicina Clínica/organização & administração , Medicina Clínica/normas , Registros Eletrônicos de Saúde/tendências , Previsões , Acessibilidade aos Serviços de Saúde/tendências , Humanos , Equipe de Assistência ao Paciente/tendências , Assistência Centrada no Paciente/tendências , Serviços Preventivos de Saúde/tendências , Qualidade da Assistência à Saúde/tendências , Estados UnidosAssuntos
Prestação Integrada de Cuidados de Saúde , Convênios Hospital-Médico/economia , Hospitais , Corpo Clínico Hospitalar/tendências , Médicos/economia , Prestação Integrada de Cuidados de Saúde/economia , Economia Hospitalar , Convênios Hospital-Médico/tendências , Hospitais/tendências , Corpo Clínico Hospitalar/economia , Salários e Benefícios , Estados Unidos , Recursos HumanosAssuntos
Acesso à Informação , Setor de Assistência à Saúde/normas , Seguro Saúde/normas , Patient Protection and Affordable Care Act , Qualidade da Assistência à Saúde , Honorários Médicos , Setor de Assistência à Saúde/economia , Preços Hospitalares , Humanos , Seguro Saúde/economia , Privacidade , Procedimentos Desnecessários/estatística & dados numéricosAssuntos
Tabela de Remuneração de Serviços/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Imposto de Renda/legislação & jurisprudência , Medicare/legislação & jurisprudência , Médicos/economia , Legislação como Assunto , Formulação de Políticas , Política , Fatores de Tempo , Estados UnidosRESUMO
This Viewpoint describes the new voluntary Center for Medicare and Medicaid Innovation Enhancing Oncology Model for cancer bundled payments, explores its likelihood of success, and discusses potential shortcomings.
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Medicare , Neoplasias , Idoso , Humanos , Estados Unidos , Mecanismo de Reembolso , Neoplasias/genética , Neoplasias/terapia , OncologiaAssuntos
Medicare/economia , Patient Protection and Affordable Care Act/economia , Readmissão do Paciente/economia , Qualidade da Assistência à Saúde/normas , Reembolso de Incentivo , Redução de Custos , Insuficiência Cardíaca/terapia , Humanos , Área Carente de Assistência Médica , Infarto do Miocárdio/terapia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Readmissão do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente , Pneumonia/terapia , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde/economia , Estados UnidosRESUMO
We conducted interviews with senior executives at 10 leading health systems to better understand how organizations use performance-based compensation. Of the organizations interviewed, five pay physicians using productivity-independent salaries, and five use productivity-adjusted salaries. Performance-based pay is more prevalent in primary care than in subspecialties, and the most consistently identified performance domains are quality, service, productivity, and citizenship. Most organizations have less than 10% of total compensation at risk, with payments distributed across three to five domains, each containing several metrics. Approaches with many metrics--and little at-risk compensation for each metric-may offer weak incentive to achieve any particular goal.