The U.S. healthcare industry, spurred by 1) actions taken by the federal government and 2) widespread opinion that the current rate of increase in healthcare expenditures is unsustainable, has turned towards value-based purchasing as an aid to control costs and retain quality of care. One type of value-based purchasing, bundled payment reimbursement, involves having the payor of healthcare serv...

The Secretary of the Department of Health and Human Services (HHS) hereby issues this final rule with comment period to implement a methodology and payment rates for the Indian Health Service (IHS) Purchased/Referred Care (PRC), formerly known as the Contract Health Services (CHS), to apply Medicare payment methodologies to all physician and other health care professional services and non-hospi...

INTRODUCTION The logic of paying more for high-quality care and less for low-quality resonates. Increasingly health system leaders worldwide acknowledge that payment reforms are needed to do just that, prompted no doubt by the growing body of evidence indicating that quality is not what it should be. PURPOSE This review was undertaken to explore contexts in which quality-based payment appears...

Importance Medicare launched the mandatory Comprehensive Care for Joint Replacement bundled payment model in 67 urban areas for approximately 800 hospitals following its experience in the voluntary Acute Care Episodes (ACE) and Bundled Payments for Care Improvement (BPCI) demonstration projects. Little information from ACE and BPCI exists to guide hospitals in redesigning care for mandatory joi...

BACKGROUND A tariff modulation mechanisms has been introduced in some Italian regions with the aim of reducing inappropriate admissions and improving quality of care. In response to a regional act, hospitals in Lazio adopted a clinical pathway for elderly patients with hip fracture and introduced a compensation system based on the quality of health care, as in a pay-for-performance model. The o...

OBJECTIVE Using insurance claims for hemorrhoidectomies, we examined the effect of Taiwan's Bureau of National Health Insurance's case payment system, a fixed case payment rate method used to reimburse health care providers for in-patient care. DESIGN This observational natural experimental study examined changes in medical care that occurred between two phases: the 9 months before case payme...

Historically, Medicare reimbursed health care facilities on the basis of costs. Cost based reimbursement methods have long been criticized because they are often complex, provide few incentives for furnishing care efficiently, and result in unpredictable payments. Because of the rapid rate of growth in outlays for inpatient hospital care, Congress first directed implementation of a prospective ...

Several federal bodies provide ongoing analyses of the Medicare DRG prospective hospital payment system. Many states are using DRG prospective "all payor systems" for hospital reimbursement (based on the federal model). In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; New York State has been All Payor since 1/1/88. This study simulated DRG ...