Pitfalls and Potential in Medicare's Move Toward Outpatient Care Episodes
Authors: Amol S. Navathe, Ezekiel J. Emanuel, Joshua M. Liao
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions4 December 2018Pitfalls and Potential in Medicare's Move Toward Outpatient Care EpisodesAmol S. Navathe, MD, PhD, Ezekiel J. Emanuel, MD, PhD, and Joshua M. Liao, MD, MScAmol S. Navathe, MD, PhDUniversity of Pennsylvania Perelman School of Medicine and Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (A.S.N.)Search for more papers by this author, Ezekiel J. Emanuel, MD, PhDUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (E.J.E.)Search for more papers by this author, and Joshua M. Liao, MD, MScUniversity of Washington School of Medicine and UW Medicine Value and Systems Science Lab, Seattle, Washington (J.M.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2563 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To improve the value of U.S. health care, Medicare has implemented episode-based bundled payments for a range of surgical procedures and medical conditions. With this approach, the agency pays provider organizations a fixed amount per care episode—a period defined by a prespecified trigger (for example, hospitalization) and duration (for example, 90 days after discharge)—and holds them financially accountable for episode quality and costs.To date, Medicare has exclusively designed inpatient episodes triggered by hospitalization and spanning up to 90 days after discharge. These efforts have produced mixed results, generating savings for joint replacement surgery but not medical conditions that may ...References1. Dummit LA, Kahvecioglu D, Marrufo G, Rajkumar R, Marshall J, Tan E, et al. Association between hospital participation in a Medicare bundled payment initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA. 2016;316:1267-78. [PMID: 27653006] doi:10.1001/jama.2016.12717 CrossrefMedlineGoogle Scholar2. Joynt Maddox KE, Orav EJ, Zheng J, Epstein AM. Evaluation of Medicare's bundled payments initiative for medical conditions. N Engl J Med. 2018;379:260-9. [PMID: 30021090] doi:10.1056/NEJMsa1801569 CrossrefMedlineGoogle Scholar3. Navathe AS, Shan E, Liao JM. What have we learned about bundling medical conditions? Health Affairs Blog. 28 August 2018. Accessed at www.healthaffairs.org/do/10.1377/hblog20180828.844613/full on 24 September 2018. Google Scholar4. Struijs JN. How bundled health care payments are working in the Netherlands. NEJM Catalyst. 11 April 2016. Accessed at https://catalyst.nejm.org/how-bundled-health-care-payments-are-working-in-the-netherlands on 24 September 2018. Google Scholar5. Centers for Medicare & Medicaid Services. BPCI Advanced. Updated 13 September 2018. Accessed at https://innovation.cms.gov/initiatives/bpci-advanced on 24 September 2018. Google Scholar6. Centers for Medicare & Medicaid Services. Merit-based Incentive Payment System (MIPS): Episode-Based Cost Measure Field Test Reports Frequently Asked Questions (FAQs). October 2017. Accessed at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Cost-Measures-Field-Test-FAQs.pdf on 24 September 2018. Google Scholar7. Centers for Medicare & Medicaid Services. MACRA. Updated 21 September 2018. Accessed at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html on 24 September 2018. Google Scholar8. U.S. Department of Health and Human Services. The PTAC Preliminary Review Team's Questions on Multi-provider, Bundled Episode-of-care Payment Model for Treatment of Chronic Hepatitis C Virus (HCV) using Care Coordination by Employed Physicians in Hospital Outpatient Clinics Submitted by the New York City Department of Health and Mental Hygiene. Accessed at https://aspe.hhs.gov/system/files/pdf/255906/NYCDOHMHAddlInfofromSubmitter.pdf on 24 September 2018. Google Scholar9. Centers for Medicare & Medicaid Services. Oncology Care Model. Updated 7 September 2018. Accessed at https://innovation.cms.gov/initiatives/oncology-care on 24 September 2018. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Pennsylvania Perelman School of Medicine and Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (A.S.N.)University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (E.J.E.)University of Washington School of Medicine and UW Medicine Value and Systems Science Lab, Seattle, Washington (J.M.L.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2563.Corresponding Author: Joshua M. Liao, MD, MSc, University of Washington, 1959 NE Pacific Street, Seattle, WA 98115; e-mail, [email protected]edu.Current Author Addresses: Dr. Navathe: University of Pennsylvania, 423 Guardian Drive, Blockley 1108, Philadelphia, PA 19104.Dr. Emanuel: University of Pennsylvania, 423 Guardian Drive, Blockley 14th Floor, Philadelphia, PA 19104.Dr. Liao: University of Washington, 1959 NE Pacific Street, Seattle, WA 98115.Author Contributions: Conception and design: A.S. Navathe, E.J. Emanuel, J.M. Liao.Drafting of the article: A.S. Navathe, E.J. Emanuel, J.M. Liao.Critical revision of the article for important intellectual content: A.S. Navathe, E.J. Emanuel, J.M. Liao.Final approval of the article: A.S. Navathe, E.J. Emanuel, J.M. Liao.Administrative, technical, or logistic support: J.M. Liao.This article was published at Annals.org on 20 November 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Impact of Medicare's Alternative Payment Models on the Value of CareWhich Needle in Which Haystack? Multisystem Care for Pulmonary Hypertension Patients 4 December 2018Volume 169, Issue 11Page: 802-803KeywordsHepatitis CHospitalizationsInpatientsMedicareMetabolic disordersMotivationOutpatient clinicsOutpatientsPercutaneous coronary interventionStable coronary artery disease ePublished: 20 November 2018 Issue Published: 4 December 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...