Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Results
The search terms yielded 465 total references. Of these, 63 were identified as potentially relevant through a screen of the abstracts. To be eligible for inclusion, a publication needed to discuss the use of episodes for performance measurement and/or payment, the attribution of responsibility for the episode of care, or grouping individual
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Methods
We searched the databases PubMed, SSRN, EconLit, Sociological Abstracts, Business Practices and Management, and Conference Proceedings for articles published between January 1, 1985 and December 31, 2007. Search terms included episode AND payment OR reimbursement OR performance OR quality; bundl* AND payment OR reimbursement OR performance OR q
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. 4. Literature Review and Expert Discussions
In this chapter, we summarize our findings from a systematic review of the literature on the use and proposed use of episode-based approaches to payment, performance measurement, and accountability. We also present the results from our discussions with a small set of experts, where we explored issues related to constructing and using episodes o
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Summary
In recent years, in an effort to assure quality health care, CMS has implemented performance measurement programs for six health care settings: hospital inpatient, hospital outpatient, physician services, skilled nursing facilities, home health care agencies, and dialysis facilities, that include a mixture of financial (for reporting) and non-fina
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Cataloging the Set of Performance Measures Contained in CMS Performance Measurement Systems
This section provides brief descriptions of the six CMS performance measurement programs. Table 2 summarizes the number of measures included in the programs by measure type (e.g. clinical process of care, patient experience). Nearly 70 percent of the measures across the programs are clinical process of care measures (173 measures). All of the perf
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. 3. Performance Measures Reported to Medicare
In 2002, CMS launched the Quality Initiative, an effort designed to assure quality health care for all Americans through performance accountability and public disclosure of performance results ( http://www.cms.hhs.gov , 2008). The roll-out of this program has occurred over the past few years, continues to expand, and includes performance measur
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. 2. Medicare Payment Policy
Medicare uses separate payment mechanisms for each of its FFS provider settings and Medicare Advantage plans. Our review finds that these payments are currently not aligned in ways that stimulate coordination, shared accountabilities, and delivery of high quality care.
We summarized the current Medicare payment systems for each provider or s
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. About This Report
The Assistant Secretary for Planning and Evaluation (ASPE) contracted with RAND in September 2007 to examine episodes of care for different clinical events/conditions and to consider ways in which the alignment of quality and financial incentives could be improved within the current Medicare payment and performance measurement systems and to explo
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. The Potential Use of Episodes of Care as a Unit of Measure
Efforts to focus on an episode of care for a patient attempt to change the current fragmented environment which is service oriented to one that takes a more holistic view of the care process.
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Goal of This Study
The Assistant Secretary for Planning and Evaluation (ASPE) contracted with RAND to explore how episodes of care could be defined for a limited set of clinical events/conditions and, based on varying definitions, to consider ways in which the alignment of performance measurement, accountability, and incentives to providers could be improved within
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. The Cost and Quality Problem
Substantial deficits in the quality of health care and persistent and unsustainable growth in health care spending have led to calls for reforms of the Medicare system, including such steps as increasing performance accountability and making changes in payment policies (IOM, 2001; IOM, 2006). Deficiencies in the quality of care delivered to pati
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Abbreviations
ABBREVIATIONS
Abbreviation
Definition
ACEI
Angiotensin converting enzyme inhibitor
ACO
Accountable care organizations
AMI
Acute myocardial infarction
APC
Ambulatory payment classification
APU
Annual payment update
ARB
Angiotensin receptor blocker
ASC
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Acknowledgments
We gratefully acknowledge the participation of numerous individuals who were instrumental in helping us complete this project. In particular, we appreciate the contributions made by our Technical Expert Panel members, who provided feedback on our data analyses and who served as external reviewers of this report. The panel members were: Ro
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Future Research and Demonstration Opportunities
There is an absence of solid empirical work related to and few real-world applications of episode-based approaches that provide guidance on how best to construct and apply episodes of care in the context of performance measurement and/or payment policy. The work done within this project was exploratory in nature and represents only a first step
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Potential Applications of Episodes of Care Along a Continuum of Policy Reform Options
There are a number of ways in which episode-of-care based approaches to performance measurement and payment potentially could be incorporated into Medicare—in the near term within existing Medicare payment and program structures as well as over a longer period of time, by building capacity and through reform of existing structures. Although no
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Findings from Exploratory Analyses of Constructed Episodes
We conducted a series of analyses using episodes of care generated by two commercial episode groupers, Symmetry ETGs and Thomson MEGs to explore issues related to constructing and using episodes of care the purposes of measurement and aligning incentives to deliver high quality care. The study population for this work consisted of FFS beneficiarie
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Risk Adjustment of Episodes of Care for Payment and Performance Measurement
Most proposals in the literature acknowledge the need to risk-adjust (i.e., adojust for differences in patient populations across providers) episodes of cre for payment and some en a provider represents only a small fraction of all the care delivered and/or does not view her/himtypes of performance measurement, particularly for outcome measures.
