TITLE

Large Variations In Medicare Payments For Surgery Highlight Savings Potential From Bundled Payment Programs

AUTHOR(S)
Miller, David C.; Gust, Cathryn; Dimick, Justin B.; Birkmeyer, Nancy; Skinner, Jonathan; Birkmeyer, John D.
PUB. DATE
November 2011
SOURCE
Health Affairs;Nov2011, Vol. 30 Issue 11, p2107
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Payers are considering bundled payments for inpatient surgery, combining provider reimbursements into a single payment for the entire episode. We found that current Medicare episode payments for certain inpatient procedures varied by 49-130 percent across hospitals sorted into five payment groups. Intentional differences in payments attributable to such factors as geography or illness severity explained much of this variation. But after adjustment for these differences, per episode payments to the highest-cost hospitals were higher than those to the lowest-cost facilities by up to $2,549 for colectomy and $7,759 for back surgery. Postdischarge care accounted for a large proportion of the variation in payments, as did discretionary physician services, which may be driven in turn by variations in surgeons' practice styles. Our study suggests that bundled payments could yield sizable savings for payers, although the effect on individual institutions will vary because hospitals that were relatively expensive for one procedure were often relatively inexpensive for others. More broadly, our data suggest that many hospitals have considerable room to improve their cost efficiency for inpatient surgery and should look for patterns of excess utilization, particularly among surgical specialties, other inpatient specialist consultations, and various types of postdischarge care.
ACCESSION #
67671009

 

Related Articles

  • Physicians With The Least Experience Have Higher Cost Profiles Than Do Physicians With The Most Experience. Mehrotra, Ateev; Reid, Rachel O.; Adams, John L.; Friedberg, Mark W.; Mcglynn, Elizabeth A.; Hussey, Peter S. // Health Affairs;Nov2012, Vol. 31 Issue 11, p2453 

    Health plans and Medicare are using cost profiles to identify which physicians account for more health care spending than others. By identifying the costliest physicians, health plans and Medicare hope to craft policy interventions to reduce total health care spending. To identify which...

  • Hospital Payment Based On Diagnosis-Related Groups Differs In Europe And Holds Lessons For The United States. Quentin, Wilm; Scheller-Kreinsen, David; Blümel, Miriam; Geissler, Alexander; Busse, Reinhard // Health Affairs;Apr2013, Vol. 32 Issue 4, p713 

    England, France, Germany, the Netherlands, and Sweden spend less as a share of gross domestic product on hospital care than the United States while delivering high-quality services. All five European countries have hospital payment systems based on diagnosis-related groups (DRGs) that classify...

  • The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause. Lee, David W.; Levy, Frank // Health Affairs;Aug2012, Vol. 31 Issue 8, p1876 

    The growth in the use of advanced imaging for Medicare beneficiaries decelerated in 2006 and 2007, ending a decade of growth that had exceeded 6 percent annually. The slowdown raises three questions. Did the slowdown in growth of imaging under Medicare persist and extend to the non-Medicare...

  • Critical Technology for a Medical Practice. Rosenberg, Patti // Physician Executive;Mar/Apr2004, Vol. 30 Issue 2, p36 

    The article considers advantages and disadvantages of various ways to automate medical profession including adding on the current system, outsourcing or buying a new system. The article considers advantages and disadvantages of various ways to automate medical profession including adding on the...

  • eRx update: The 'other' government incentive program you need to know. Woodcock, Elizabeth // Dermatology Times;Feb2012, Vol. 33 Issue 2, p70 

    The article focuses on the Electronic Prescribing (eRx) Incentive Program of the U.S. government in 2009 which is authorized under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). It mentions that eRx is straightforward and the qualification criteria are unambiguous...

  • CODING AND REIMBURSEMENT.  // Audiology Today;Mar/Apr2011, Vol. 23 Issue 2, p54 

    The article offers updates on medical coding and reimbursement in the U.S. It announces the changes in the Physician Quality Reporting Initiative (PQRI) in 2011. It notes that the Centers for Medicare and Medicaid Services (CMS) and Office of the Inspector General (OIG) have started programs to...

  • Quality caregivers. McKinney, Maureen // Modern Healthcare;3/3/2014, Vol. 44 Issue 9, p18 

    The article focuses on Truven's U.S. 100 Top Hospital list released by U.S.-based Truven Health Analytics that ranked hospitals according to their patient care performances. It mentions several parameters on which the hospitals were evaluated that include deployment of information technology...

  • Avoiding Unintended Incentives In ACO Payment Models. Douven, Rudy; McGuire, Thomas G.; McWilliams, J. Michael // Health Affairs;Jan2015, Vol. 34 Issue 1, p142 

    One goal of the Medicare Shared Savings Program for accountable care organizations (ACOs) is to reduce Medicare spending for ACOs' patients relative to the organizations' spending history. However, we found that current rules for setting ACO spending targets (or benchmarks) diminish ACOs'...

  • Shoulder arthropathy outcomes 3 decades after Bristow repair for instability described.  // Orthopedics Today;Apr2014, Vol. 34 Issue 4, p16 

    The article discusses research presented by physician Lennart Hovelius at the American Academy of Orthopaedic Surgeons that was held from March 11-15, 2014 in New Orleans, Louisiana, describing shoulder arthropathy outcomes three decades after Bristow-Latarjet repair for instability.

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics