Purpose Of Review: Episode-based cost measures (EBCM) is a method of combining all services related to a defined episode of care, identified as either a procedure, acute illness or chronic disease, and providing expected cost for that episode or bundle of care. Procedural EBCM has become a major scheme for payment methodology and patient quality of care evaluation. Anesthesiologists need to know how EBCM can impact their clinical practice.
Recent Finding: Centers for Medicare and Medicaid Services (CMS) pays physicians with fee-for-service payment for Clinical Episodes and, in 2020, the EBCM are increasing and currently, represents 4.5% of the total Medicare Part A and B spending [1]. With the recent changes in CMS, it is important, for anesthesia providers to know how cost attribution identifies the cost for all services and complications under anesthetic management.
Summary: EBCM can impact the anesthesiologist's quality performance, efficiencies measures, and payment. To preserve practice viability, anesthesiologists must understand how their compensation is impacted by services ordered. Anesthesiologists will increasingly be expected to improve quality and efficiencies in EBCM.
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http://dx.doi.org/10.1097/ACO.0000000000000976 | DOI Listing |
Hand (N Y)
December 2024
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
JAMA Netw Open
December 2024
Center for Advancing Health Services, Policy & Economics Research, Institute for Public Health, Washington University, St Louis, Missouri.
Importance: Hospital participation in the Bundled Payments for Care Improvement-Advanced (BPCI-A) initiative has been associated with modest savings and stable clinical outcomes overall, but it is unknown whether the program performs differently for medical and surgical or procedural (henceforth, surgical) episodes.
Objective: To assess the association of BPCI-A participation with Medicare spending and clinical outcomes for medical and surgical episodes.
Design, Setting, And Participants: This retrospective difference-in-differences cohort study utilized 100% Medicare fee-for-service inpatient claims for episodes initiated between January 1, 2017, and September 30, 2019, and included 90 days of follow-up.
Influenza Other Respir Viruses
July 2024
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Background: The cost of medically attended RSV LRI (lower respiratory infection) is critical in determining the economic value of new RSV immunoprophylaxes. However, most studies have focused on intermittent RSV encounters, not the episode of care that captures the entirety of RSV illness.
Methods: We created age- and condition-specific cohorts of children under 5 years of age using MarketScan® data (2015-2019).
Am J Manag Care
June 2024
University of Michigan, 2800 Plymouth Rd, Bldg 16, Ann Arbor, MI 48109. Email:
Objectives: To understand hospitals' approaches to spending reduction in commercial episode-based payment programs and inform incentive design.
Study Design: Qualitative arm of an explanatory sequential mixed-methods study involving semistructured interviews with hospital leaders participating in a statewide quality improvement collaborative with novel episode-based incentive payments introduced by the state's largest commercial payer.
Methods: We recruited 21 leaders from 8 purposively selected, diverse hospitals with both high and low performance.
Ann Hepatobiliary Pancreat Surg
August 2024
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore.
This systematic review and meta-analysis aimed to evaluate the impact of prospective payment systems (PPSs) on cholecystectomy. A comprehensive literature review was conducted, examining studies published until December 2023. The review process focused on identifying research across major databases that reported critical outcomes such as length of stay (LOS), mortality, complications, admissions, readmissions, and costs following PPS for cholecystectomy.
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