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In Setting Doctors' Medicare Fees, CMS Almost Always Accepts the Relative Value Update Panel's Advice on Work Values

May 1, 2012 | Journal Article

To calculate physicians' fees under Medicare, which in turn influence the physician fee schedules of other public and private payers, one of the essential decisions the Centers for Medicare and Medicaid Services must make is how much physician time and effort, or work, is associated with various physician services.

The PROMETHEUS Bundled Payment Experiment

November 1, 2011 | Journal Article

One of the leading alternative payment models proposed in the Affordable Care Act of 2010 is bundled payment, which provides payment for all of the care a patient needs over the course of a defined clinical episode, instead of paying for each discrete service. We evaluated the initial "road test" of PROMETHEUS Payment, one of several bundled payment pilot projects.

Building a Bridge from Fragmentation to Accountability

September 10, 2009 | Journal Article

The PROMETHEUS Payment approach seeks to promote and reward high-quality, efficient, patient-centered health care by using a novel method to pay hospitals and physicians and other providers. The PROMETHEUS Payment model consists of three components: evidence-informed base payments with patient-specific severity adjustments and an allowance for potentially avoidable complications.

From Volume to Value

September 1, 2009 | Journal Article

This study proposes two methods of payment reform that could facilitate higher quality and lower cost "episode-of-care payment" and "comprehensive care payment" (condition-adjusted capitation).

Quality-Based Payment for Medical Groups and Individual Physicians

July 1, 2009 | Journal Article

This survey on quality-based payment found that the prevalence of external performance bonuses paid by insurers to large medical groups is larger than the prevalence of performance bonuses paid by the medical groups to the primary care and specialist physicians.

Should Health Care Come with a Warranty?

June 16, 2009 | Journal Article

This article examines a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers' behavior and profitability.

Fostering Accountable Health Care

January 27, 2009 | Journal Article

To succeed, health care reform must slow spending growth while improving quality. In this paper the authors propose a realignment of payment incentives to better support the most important drivers of improvement in care: health care providers.

Supplemental Coverage Associated With More Rapid Spending Growth for Medicare Beneficiaries

May 6, 2013 | Journal Article

This is the first empirical study to investigate whether supplemental Medicare coverage is associated with higher rates of spending growth over time.

Policy Makers Will Need a Way to Update Bundled Payments That Reflects Highly Skewed Spending Growth of Various Care Episodes

May 6, 2013 | Journal Article

Bundled payment is seen as a promising way to slow the growth of health care spending while maintaining or improving the quality of care.

Fee-For-Service Will Remain A Feature Of Major Payment Reforms, Requiring More Changes In Medicare Physician Payment

September 1, 2012 | Journal Article

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global paym ...