ABSTRACT
While health care evolves from volume to value, there is increasing interest by payors to use patient-reported outcomes (PROs) to determine value and more specifically, quality from the patient's perspective. This article reviews the current state of PROs and discusses future directions. Specifically, this article will review the current history and background of PROs; it will highlight the perspective of the National Quality Forum and review the efforts of the musculoskeletal community related to PROs. Goals, positive aspects, limitations, and barriers related to PROs will be discussed. Additionally, development considerations and strategies will be highlighted. Finally, development recommendations from the American Academy of Orthopaedic Surgery position statement "principles for musculoskeletal based PRO performance measurement development" will be introduced.
Subject(s)
Disability Evaluation , Musculoskeletal Diseases/surgery , Orthopedic Procedures/standards , Outcome Assessment, Health Care , Patient Reported Outcome Measures , HumansABSTRACT
Although the Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January 2013, it may be years before the data can determine if the BPCI Initiative enhances value without decreasing quality. Private insurers have implemented other bundled payment arrangements for the delivery of total joint arthroplasty in a variety of practice settings. It is important for surgeons to review the early results of the BPCI Initiative and other bundled payment arrangements to understand the challenges and benefits of healthcare delivery systems with respect to total joint arthroplasty. In addition, surgeons should understand methods of cost control and quality improvement to determine the effect of the BPCI Initiative on the value-quality equation with respect to total joint arthroplasty.
Subject(s)
Arthroplasty, Replacement , Cost Control/methods , Patient Care Bundles/economics , Quality Assurance, Health Care/methods , Arthroplasty, Replacement/economics , Arthroplasty, Replacement/methods , Humans , Insurance, Health, Reimbursement , Medicare/economics , Practice Patterns, Physicians'/economics , Practice Patterns, Physicians'/standards , United StatesABSTRACT
The Patient Protection and Affordable Care Act contains a number of provision for improving the delivery of healthcare in the United States, among the most impactful of which may be the call for modifications in the packaging of and payment for care that is bundled into episodes. The move away from fee for service payment models to payment for coordinated care delivered as comprehensive episodes is heralded as having great potential to enhance quality and reduce cost, thereby increasing the value of the care delivered. This effort builds on the prior experience around delivering care for arthroplasty under the Acute Care Episode Project and offers extensions and opportunities to modify the experience moving forward. Total hip and knee arthroplasties are viewed as ideal treatments to test the effectiveness of this payment model. Providers must learn the nuances of these modified care delivery concepts and evaluate whether their environment is conducive to success in this arena. This fundamental shift in payment for care offers both considerable risk and tremendous opportunity for physicians. Acquiring an understanding of the recent experience and the determinants of future success will best position orthopaedic surgeons to thrive in this new environment. Although this will remain a dynamic exercise for some time, early experience may enhance the chances for long term success, and physicians can rightfully lead the care delivery redesign process.
Subject(s)
Centers for Medicare and Medicaid Services, U.S./trends , Delivery of Health Care/trends , Patient Care Bundles/economics , Patient Protection and Affordable Care Act/trends , Quality of Health Care/economics , Reimbursement Mechanisms/trends , Arthroplasty, Replacement, Hip/economics , Arthroplasty, Replacement, Knee/economics , Centers for Medicare and Medicaid Services, U.S./economics , Delivery of Health Care/economics , Fee-for-Service Plans/economics , Health Care Costs/trends , Health Care Reform/economics , Humans , Orthopedics/economics , Patient Protection and Affordable Care Act/economics , Reimbursement Mechanisms/economics , Retrospective Studies , United StatesABSTRACT
A panel of hospital executives and industry experts came together in Chicago recently to discuss the transformational initiatives that can lead to the delivery of high-value health care. Here's what they had to say about the critical changes in infrastructure and care processes that will be necessary.
Subject(s)
Delivery of Health Care/organization & administration , Quality of Health Care/organization & administration , Benchmarking/organization & administration , Continuity of Patient Care/organization & administration , Cost Savings , Cost-Benefit Analysis , Delivery of Health Care/economics , Humans , Insurance, Health, Reimbursement , Patient Satisfaction , Physician's Role , Quality Indicators, Health Care , Quality of Health Care/economics , Rural Health Services/organization & administration , Systems IntegrationSubject(s)
Health Facility Administrators/statistics & numerical data , Physician Executives/statistics & numerical data , Chief Executive Officers, Hospital/statistics & numerical data , Data Collection , Health Facility Administrators/education , Job Description , Physician Executives/education , United StatesABSTRACT
To establish an effective, and lasting, collaboration with physicians, a hospital must: Create a positive vision of the future. Structure the collaboration to reflect market imperatives. Work only with the best partners and make it clear from the start what the expectations are for those partners. Establish accounting and governance practices that promote the venture's near-term profitability and the long-term goals.
