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1.
安磊么莉冯晶晶詹磊磊尚文涵李伟王凯 《中国卫生质量管理》2022,(4):009-12
梳理了美国医保支付制度改革进程,总结了捆绑支付模式内涵及其对康复护理服务的影响。结合我国国情,借鉴美国医保支付制度改革经验,认为我国应建立基于价值评价的康复护理服务医保支付制度,充分发挥医保基金的引导和保障作用,健全多元化的复合型医保支付体系,创建“以人民的健康为中心”的连续型医疗服务保障体系。 相似文献
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Islam Abdelrahman Ingrid Steinvall Mats Fredrikson Folke Sjoberg Moustafa Elmasry 《Burns : journal of the International Society for Burn Injuries》2019,45(2):303-309
Background
To our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care.Methods
All patients admitted with burns during the period 2010–15 were included. We analysed clinical and economic data from the daily burn scores during the acute phase of the burn until discharge from the burn centre.Results
Total median charge/patient was US$ 28 199 (10th–90th centiles 4668-197 781) for 696 patients admitted. Burns caused by hot objects and electricity resulted in the highest charges/TBSA%, while charges/day were similar for the different causes of injury. Flame burns resulted in the highest mean charges/admission, probably because they had the longest duration of stay. Mean charges/patient increased in a linear fashion among the different age groups.Conclusion
Our intervention-based estimate of charges has proved to be a valid tool that is sensitive to the procedures that drive the costs of the care of burns such as large TBSA%, intensive care, and operations. The burn score system could be reproduced easily in other burn centres worldwide and facilitate the comparison regardless of the differences in the currency and the economic circumstances. 相似文献3.
《Seminars in Arthroplasty》2016,27(3):151-162
Since the passage of the Patient Protection and Affordable Care Act (PPACA), the Centers for Medicare and Medicaid Services (CMS) has been mandated to transform from a passive consumer to an active purchaser of healthcare. The goal of this article is to report on the various bundle payment initiatives [Acute Care Episode Demonstration Project (ACE-DP), Bundle Payment for Care Improvement (BPCI), and Comprehensive Care for Joint Replacement (CJR)] sanctioned by CMS, and how these innovative reimbursement systems may affect orthopedic practice. The authors will also speculate on future reimbursement systems and how they may be integrated with big data principles to further enhance the quality and efficiency of orthopedic care. 相似文献
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Background
As early implementors of the Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative, our private practice sought to compare our readmission rates, post-acute care utilization, and length of stay for the first year under BPCI compared to baseline data.Methods
We used CMS data to compare total expenditures of all diagnosis-related groups (DRGs). Medicare patients who underwent orthopedic surgery between 2009 and 2012 were defined as non-BPCI (n = 8415) and were compared to Medicare BPCI patients (n = 4757) who had surgery in 2015. Ninety-day post-acute events including inpatient rehabilitation facility or subacute nursing facility admission, home health (HH), and readmissions were analyzed.Results
The median expenditure for non-BPCI patients was $22,193 compared to $19,476 for BPCI patients (P < .001). Median post-acute care spend was $6861 for non-BPCI and $5360 for BPCI patients (P < .001). Compared to non-BPCI patients, BPCI patients had a lower rate of subacute nursing facility admissions (non-BPCI 43% vs 37% BPCI; P < .001), inpatient rehabilitation facility admissions (non-BPCI 3% vs 4% BPCI; P = .005), HH (non-BPCI 79% vs 73% BPCI; P < .001), and readmissions (non-BPCI 12% vs 10% BPCI; P = .02). Changes in length of stay for post-acute care were only significant for HH with BPCI patients using a median 12 days and non-BPCI using 24 days.Conclusion
The objective of BPCI was to improve healthcare value. Through substantial efforts both financially and utilization of human resources to contain costs with clinical practice guidelines, patient navigators, and a BPCI management team, the expenditures for CMS were significantly lower for BPCI patients. 相似文献6.
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Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in ghana 下载免费PDF全文
Summary BACKGROUND: The Government of Ghana's fee exemption policy for delivery care introduced in September 2003, aimed at reducing financial barriers to using maternal services. This policy also aimed to increase the rate of skilled attendance at delivery, reduce maternal and perinatal mortality rates and contribute to reducing poverty. OBJECTIVE: To evaluate the economic outcomes of the policy on households in Ghana. METHODS: Central and Volta regions were selected for the study. In each region, six districts were selected. A two stage sampling approach was used to identify women for a household cost survey. A sample of 1500 women in Volta region (made up of 750 women each before and after the exemption policy) and 750 women after the policy was introduced in Central region. OUTCOME MEASURES: Household out-of-pocket payment for maternal delivery and catastrophic out-of-pocket health payments. RESULTS: There was a statistically significant decrease in the mean out-of-pocket payments for caesarean section (CS) and normal delivery at health facilities after the introduction of the policy. The percentage decrease was highest for CS at 28.40% followed by normal delivery at 25.80%. The incidence of catastrophic out-of-pocket payments also fell. At lower thresholds, the incidence of catastrophic delivery payment was concentrated more amongst the poor. For the poorest group (1(st) quintile) household out-of-pocket payments in excess of 2.5% of their pre-payment income dropped from 54.54% of the households to 46.38% after the exemption policy. The policy had a more positive impact on the extreme poor than the poor. The richest households (5(th) quintile) had a decline in out-of-pocket payments of 21.51% while the poor households (1(st) quintile) had a 13.18% decline. CONCLUSIONS: The policy was beneficial to users of the service. However, the rich benefited more than the poor. There is need for proper targeting to identify the poorest of the poor before policies are implemented to ensure maximum benefit by the target group. 相似文献
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Kern Singh Sreeharsha V. Nandyala Alejandro Marquez-Lara Steven J. Fineberg Mathew Oglesby Miguel A. Pelton Gunnar B. Andersson Darya Isayeva Briana J. Jegier Frank M. Phillips 《The spine journal》2014,14(8):1694-1701
Background contextEmerging literature suggests superior clinical short- and long-term outcomes of MIS (minimally invasive surgery) TLIFs (transforaminal lumbar interbody fusion) versus open fusions. Few studies to date have analyzed the cost differences between the two techniques and their relationship to acute clinical outcomes.PurposeThe purpose of the study was to determine the differences in hospitalization costs and payments for patients treated with primary single-level MIS versus open TLIF. The impact of clinical outcomes and their contribution to financial differences was explored as well.Study design/settingThis study was a nonrandomized, nonblinded prospective review.Patient sampleSixty-six consecutive patients undergoing a single-level TLIF (open/MIS) were analyzed (33 open, 33 MIS). Patients in either cohort (MIS/open) were matched based on race, sex, age, smoking status, medical comorbidities (Charlson Comorbidity index), payer, and diagnosis. Every patient in the study had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis.Outcome measuresOperative time (minutes), length of stay (LOS, days), estimated blood loss (EBL, mL), anesthesia time (minutes), Visual Analog Scale (VAS) scores, and hospital cost/payment amount were assessed.MethodsThe MIS and open TLIF groups were compared based on clinical outcomes measures and hospital cost/payment data using SPSS version 20.0 for statistical analysis. The two groups were compared using bivariate chi-squared analysis. Mann-Whitney tests were used for non-normal distributed data. Effect size estimate was calculated with the Cohen d statistic and the r statistic with a 95% confidence interval.ResultsAverage surgical time was shorter for the MIS than the open TLIF group (115.8 minutes vs. 186.0 minutes respectively; p=.001). Length of stay was also reduced for the MIS versus the open group (2.3 days vs. 2.9 days, respectively; p=.018). Average anesthesia time and EBL were also lower in the MIS group (p<.001). VAS scores decreased for both groups, although these scores were significantly lower for the MIS group (p<.001). Financial analysis demonstrated lower total hospital direct costs (blood, imaging, implant, laboratory, pharmacy, physical therapy/occupational therapy/speech, room and board) in the MIS versus the open group ($19,512 vs. $23,550, p<.001). Implant costs were similar (p=.686) in both groups, although these accounted for about two-thirds of the hospital direct costs in the MIS cohort ($13,764) and half of these costs ($13,778) in the open group. Hospital payments were $6,248 higher for open TLIF patients compared with the MIS group (p=.267).ConclusionsMIS TLIF technique demonstrated significant reductions of operative time, LOS, anesthesia time, VAS scores, and EBL compared with the open technique. This reduction in perioperative parameters translated into lower total hospital costs over a 60-day perioperative period. Although hospital reimbursements appear higher in the open group over the MIS group, shorter surgical times and LOS days in the MIS technique provide opportunities for hospitals to reduce utilization of resources and to increase surgical case volume. 相似文献
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Vincent J Rossi Junyoung Ahn Daniel D Bohl Ehsan Tabaraee Kern Singh 《World journal of orthopedics》2015,6(5):409-412
The current trajectory of healthcare-related spending in the United States is unsustainable. Currently, the predominant form of reimbursement is the form of a fee-for-service system in which surgeons are reimbursed for each discrete unit of care provided. This system does factor the cost, quality, or outcomes of service provided. For the purposes of cost containment, the bundled episode reimbursement has gained popularity as a potential alternative to the current fee-for-service system. In the newer model, the spinal surgeon will become increasingly responsible for controlling costs. The bundled payment system will initially offer financial incentives to initiate a meaningful national transition from the fee-for-service model. The difficulty will be ensuring that the services of surgeons continue to be valued past this initiation period. However, greater financial responsibilities will be placed upon the individual surgeon in this new system. Over time, the evolving interests of hospital systems could result in the devaluation of the surgeons’ services. Significant cooperation on behalf of all involved healthcare providers will be necessary to ensure that quality of care does not suffer while efforts for cost containment continue. 相似文献
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Dikran Toroser Micah Robinson Julie Gegner Geoff Smith Jon Nilsen Lucy Hyatt 《Current medical research and opinion》2016,32(3):547-553
Objective:The Physician Payments Sunshine Act, enacted in 2010, is intended to increase the transparency of relationships between US physicians and teaching hospitals and manufacturers of drugs, biologics, and medical devices. We examined current opinion regarding the impact of the Sunshine Act on peer-reviewed medical publications.Research design and methods:We searched indexed databases (NLM/PubMed, EMBASE, and Scopus) and nonindexed sources (lay and medical press, medical websites, congress abstracts) for articles published between January 2010 and June 2015 that contained terms indicative of content related to the Sunshine Act (e.g., ‘Sunshine Act’, ‘open payment program’). Nine publication professionals then systematically reviewed identified articles for publications-related content.Main outcome measures:Quantification and characterization of publications that focused on the Sunshine Act and its implications for medical publishing.Results:Among 1200 indexed publications, 113 had content on the Sunshine Act. Thirty-one discussed its implications for publications; nine distinguished between financial and nonfinancial transfers of value. Of the 117 nonindexed publications with content on the Sunshine Act, 16 discussed implications for publications, and seven distinguished between financial and nonfinancial transfers of value. Reporting of such transfers of value was viewed as a potential barrier to participation in publications with industry support.Conclusions:There is limited literature on the impact of the Sunshine Act on peer-reviewed publications and limited physician awareness that publication support may be reported as a transfer of value. 相似文献