- Payment and Delivery System Reform in Medicare A PRIMER ON MEDICAL HOMES, ACCOUNTABLE CARE ORGANIZATIONS, AND BUNDLED PAYMENTS
Kaiser Family Foundation, Feb 2016 (PDF file)
- Paying Providers For Value: The Path Forward
Health Affairs, 2016 (blog post)
- Bundled Payments for Care Improvement Initiative
Health Affairs, 2015 (webpage)
- Specialty Payment Model Opportunities and Assessment Oncology Simulation Report
RAND Corp., Mar 2015 (HTML page)
This report describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model.
- Specialty Payment Model Opportunities and Assessment Gastroenterology and Cardiology Model Design Report
RAND Corp., Mar 2015 (HTML page)
The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model.
- Fact sheets: Better Care. Smarter Spending. Healthier People: Paying Providers for Value, Not Volume
CMS, Jan 2015 (web page)
- The Physician Payments Sunshine Act
Health Affairs, October 2014 (PDF file)
- Medicare's Payment to Physicians: the Budgetary Impact of Alternative Policies Relative to CBO's May 2013 Baseline updated for Final Rule
- Physician Payment Mechanisms, Hospital Length of Stay and Risk of Readmission: Evidence from a Natural Experiment
IZA, December 2013 (PDF file)
- Is the Time Right for a Permanent Fix to Medicare’s Formula for Physician Payment?
Brookings Institute, November 2013 (Blog post)
In this post, we describe the origins of the Medicare Sustainable Growth Rate and reasons for renewed optimism for a permanent fix.
- Reference Pricing and Bundled Payments
Catalyst for Payment Reform, October 2013 (PDF file)
This paper discusses how reference pricing can be successfully paired with bundled payment to create the alignment described above. First we begin with a look at an
employer and a purchaser using a reference pricing strategy today.
- Legal Issues in Designing Bundled Payments and Shared Savings Arrangements in the Commercial Payor Context
RWJF, 2013 (PDF file)
While there have been many publications and presentations on the requirements for Medicare bundled payments, there appears to be little guidance available to assist in facilitating and structuring contracts for bundled payments with commercial payors. This paper aims to address this issue and illustrate that, with the proper investment of time and resources, it is possible to create profitable and compliant bundled-payment and shared-savings arrangements with commercial payors.
- MEDICARE PHYSICIAN PAYMENT: WE GET WHAT WE PAY FOR—HOW CAN WE GET WHAT WE WANT?
Commonwealth Fund, May 2011 (PDF file)
Physicians are unique among Medicare providers in being subject to an aggregate spending adjustment. In contrast, Medicare facility-based services are paid through prospective payment systems that set a price for a bundle of services. In these systems, the provider is free to make decisions about the volume of services provided to the patient and prices paid for services and supplies, but the payment for the bundle is fixed.
- How Will Physicians Be Affected by Health Care Reform?
RWJF, 2010 (PDF file)
The coverage expansions that are at the center of health care reform will likely boost practice revenues for many physicians. In addition, provisions that require an increase in fees paid for primary care in Medicaid and Medicare will also benefit some physicians.
- Physician payment : current system and opportunities for reform
AARP, April 2009 (PDF file)
This paper is intended to provide a starting point for a discussion on how to improve payment to physicians.
- Medicare: Private Sector Initiatives to Bundle Hospital and Physician Payments for an Episode of Care
GAO, January 2011, (PDF file)
Concerns about the rising cost of health care are particularly pressing in light of evidence that suggests that greater spending does not necessarily translate to better health outcomes or higher-quality care. Medicare’s fee-for-service (FFS) payment system may contribute to spending growth because it rewards volume of services regardless of the appropriateness, cost, and quality of those services. Under FFS, a payment is made for each unit of service based on the expected costs of delivering that service.
- REFORMING PHYSICIAN PAYMENTS TO ACHIEVE GREATER VALUE IN HEALTH CARE SPENDING
A Position Paper from the American College of Physicians
- Reduce Poor Quality and Duplicative Care through Physician Teamwork
Third Way, June 2013 (PDF file)
Current behavior: Each specialist works separately and seeks payment for their individual services. New behavior: Specialists work as a team to continuously improve quality and lower costs. How to change behavior: Pay medical specialists a set and bundled payment for each episode of care.
- Obamacare’s Impact on Doctors—An Update
Heritage Foundation, August 2013 (web site)
physicians will be subject to more government regulation and oversight, and will be increasingly dependent on unreliable government reimbursement for medical services. Doctors, already under tremendous pressure, will only see their jobs become more difficult.
- Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition
National Academies Press, 2012 (web site)
The report examined the data sources and methods used to adjust payments, and it recommended a number of changes, including using the same geographic boundaries and payment areas for hospitals and health care practitioners; using different data sets for computing the compensation of clinical and administrative hospital staff and those at office-based sites; and expanding the types of occupations used to make the geographic adjustments.
- Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency
National Academies Press, 2012 (web site)
The committee’s latest report, Geographic Adjustment in Medicare Payment, Phase II: Implications for Access, Quality, and Efficiency, applies the first 2 report’s recommendations in order to determine their potential effect on Medicare payments to hospitals and clinical practitioners. The report also offers recommendations to improve access to efficient and appropriate levels of care. In addition, the committee notes the importance of ensuring the availability of a sufficient health care workforce to serve all beneficiaries, regardless of where they live.
- Variation in Health Care Spending: Target Decision Making, Not Geography
National Academies Press, Pre-publication 2013 (web site)
This report presents findings from commissioned analyses of traditional, fee-for-service Medicare (and to a lesser extent Medicare Advantage and Part C) and commercial insurance
- Why Has Growth in Spending for Fee-for-Service Medicare Slowed?
CBO, August 2013 (PDF file)
This paper focuses on the slowdown in the growth of FFS Medicare spending for elderly beneficiaries through 2010, the most recent year for which detailed survey data on beneficiaries are available.
- The Sustainable Growth Rate: Seeking a ‘Doc Fix’
Alliance for Health reform, April 2013 (PDF file)
There are several widely recognized problems associated with the SGR formula. For one, the formula is based on spending that occurred between April 1, 1996 and March 31, 1997. It therefore does not reflect the influx of baby boomers who began joining Medicare in 2011. Physicians also note that the SGR is applied uniformly across all specialties and geographic locations. This means that physicians who reduce their Medicare expenditures are not necessarily rewarded.
- Bundled Care: The Opportunities and Challenges for Providers
Booz & Company, 2013 (PDF file)
This Perspective presents survey data from providers: physicians and hospitals. (A third piece will discuss the attitudes of payors—health plans and employers—
- Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule and Other Revisions to Part B for CY 2014
Medical Group Management Association, September 2013 (PDF file)
CMS anticipates, barring changes to current law, an approximate 24.4 percent cut in physician payment rates for 2014 under the sustainable growth rate (SGR) methodology. The 24.4 percent rate cut is based on a March 2013 analysis from CMS. This massive cut will have catastrophic consequences on medical group practices and the patients they serve.
- Tulsa Hospital Gives Medicare Patients Cash Back For Surgery
Kaiser News Article, October 2009
The health care bill that the Senate Finance Committee approved earlier this month calls on Medicare to start a “bundling” project by 2013 that could involve many different types of health providers, including hospitals, doctors, home health agencies, rehabilitation facilities and nursing homes.
- Global and episodic bundling : an overview of considerations
AcademyHealth, April 2011 (PDF file)