Episode of care analysis reveals sources of variations in costs.

Objectives: To understand and reveal the underlying sources of inter- and intraplan variation in a selected number of chronic and procedural episodes.

Study Design: Analysis of allowed claims from 9 regional health plans covering commercially insured populations in different areas of the United States.

Methods: Use of the PROMETHEUS Evidence-Informed Case Rates analytics to 1) calculate total plan costs and cost of specific episodes, 2) create price and severity adjustments, and 3) determine coefficients of variation.

Making the CMS payment policy for healthcare-associated infections work: organizational factors that matter.

Healthcare-associated infections (HAIs) are among the most common adverse events in hospitals, and the morbidity and mortality associated with them are significant. In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a new financial policy that no longer provides payment to hospitals for services related to certain infections not present on admission and deemed preventable. At present, little is known about how this policy is being implemented in hospital settings.

No payment for preventable complications: reviewing the early literature for content, guidance, and impressions.

In 2008, the Centers for Medicare & Medicaid Services (CMS) implemented a policy of not paying hospitals for the care of several preventable hospital-acquired conditions. The CMS policy is a unique value-based purchasing initiative because it relies on penalties rather than on rewards. Because of its novelty, less is known in advance about how this type of payment approach might work, get implemented, or be viewed by stakeholders in health care.