We Should Measure What Matters in Bundled Payment Programs
Authors: Peter J. Pronovost, Julie Miller, David E. Newman-Toker, Lisa Ishii, Albert W. Wu
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions15 May 2018We Should Measure What Matters in Bundled Payment ProgramsPeter J. Pronovost, MD, PhD, Julie Miller, MD, David E. Newman-Toker, MD, PhD, Lisa Ishii, MD, and Albert W. Wu, MD, MPHPeter J. Pronovost, MD, PhDArmstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland (P.J.P.), Julie Miller, MDJohns Hopkins University, Baltimore, Maryland (J.M., D.E.N.), David E. Newman-Toker, MD, PhDJohns Hopkins University, Baltimore, Maryland (J.M., D.E.N.), Lisa Ishii, MDJohns Hopkins Medicine, Baltimore, Maryland (L.I.), and Albert W. Wu, MD, MPHJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (A.W.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2815 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The U.S. health care system is moving from paying for volume to paying for value by reducing fee-for-service payments and increasing fee-for-outcome payments. For example, in 2016, the Centers for Medicare & Medicaid Services (CMS) launched new programs authorized by the Medicare Access and CHIP Reauthorization Act of 2015. This act created the Merit-based Incentive Payment System, which provides for new ways to pay for care, including bundled payment programs. These programs pay a fixed amount for the total cost of care during a defined period surrounding a procedure. Commercial payers have followed this trend, and in 2016, an estimated ...References1. Health Care Payment Learning & Action Network. U.S. health care system ties 29% of payments to alternative payment models. Cision PR Newswire. 30 October 2017. Accessed at www.prnewswire.com/news-releases/us-health-care-system-ties-29-of-payments-to-alternative-payment-models-300545354.html on 29 January 2018. Google Scholar2. Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf. 2013;22 Suppl 2:ii21-7. [PMID: 23771902] doi:10.1136/bmjqs-2012-001615 CrossrefMedlineGoogle Scholar3. Liberman AL, Newman-Toker DE. Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big data. BMJ Qual Saf. 2018. [PMID: 29358313] doi:10.1136/bmjqs-2017-007032 CrossrefMedlineGoogle Scholar4. Stahel PF, VanderHeiden TF, Kim FJ. Why do surgeons continue to perform unnecessary surgery? [Editorial]. Patient Saf Surg. 2017;11:1. [PMID: 28096899] doi:10.1186/s13037-016-0117-6 CrossrefMedlineGoogle Scholar5. Brook RH. Assessing the appropriateness of care—its time has come. JAMA. 2009;302:997-8. [PMID: 19724048] doi:10.1001/jama.2009.1279 CrossrefMedlineGoogle Scholar6. Rajkumar R, Patel A, Murphy K, Colmers JM, Blum JD, Conway PH, et al. Maryland's all-payer approach to delivery-system reform. N Engl J Med. 2014;370:493-5. [PMID: 24410022] doi:10.1056/NEJMp1314868 CrossrefMedlineGoogle Scholar7. Ghomrawi HM, Schackman BR, Mushlin AI. Appropriateness criteria and elective procedures—total joint arthroplasty. N Engl J Med. 2012;367:2467-9. [PMID: 23268663] doi:10.1056/NEJMp1209998 CrossrefMedlineGoogle Scholar8. Lyman S, Lee YY, Franklin PD, Li W, Cross MB, Padgett DE. Validation of the KOOS, JR: a short-form knee arthroplasty outcomes survey. Clin Orthop Relat Res. 2016;474:1461-71. [PMID: 26926773] doi:10.1007/s11999-016-4719-1 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland (P.J.P.)Johns Hopkins University, Baltimore, Maryland (J.M., D.E.N.)Johns Hopkins Medicine, Baltimore, Maryland (L.I.)Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (A.W.W.)Acknowledgment: The authors thank Christine G. Holzmueller, BLA, for editing the manuscript that was submitted to the journal.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2815.Corresponding Author: Peter J. Pronovost, MD, PhD, UnitedHealthcare, 9700 Healthcare Way, Minnetonka, MN 55343; e-mail, peter.[email protected]com.Current Author Addresses: Dr. Pronovost: UnitedHealthcare, 9700 Healthcare Way, Minnetonka, MN 55343.Dr. Miller: Division of Cardiology, Johns Hopkins University, 600 North Wolfe Street, Halsted 568, Baltimore, MD 21287.Dr. Newman-Toker: Department of Neurology, Johns Hopkins University, 1550 Orleans Street, CRB-II, Room 2M-03 North, Baltimore, MD 21231.Dr. Ishii: Department of Otolaryngology-Head & Neck Surgery, Clinical Integration, Office of Johns Hopkins Physicians, Johns Hopkins Medicine, 601 North Caroline Street, Suite 6231, Baltimore, MD 21287.Dr. Wu: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 653, Baltimore, MD 21205.Author Contributions: Conception and design: P.J. Pronovost, J. Miller, L. Ishii, A.W. Wu.Analysis and interpretation of the data: P.J. Pronovost, J. Miller, D.E. Newman-Toker, L. Ishii.Drafting of the article: P.J. Pronovost, J. Miller, L. Ishii, A.W. Wu.Critical revision of the article for important intellectual content: P.J. Pronovost, J. Miller, A.W. Wu.Final approval of the article: P.J. Pronovost, J. Miller, D.E. Newman-Toker, L. Ishii, A.W. Wu.Administrative, technical, or logistic support: P.J. Pronovost.Collection and assembly of data: J. Miller, L. Ishii, A.W. Wu.This article was published at Annals.org on 10 April 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCrossing Academic Boundaries for Diagnostic Safety: 10 Complex Challenges and Potential Solutions From Clinical Perspectives and High-Reliability Organizing PrinciplesTwo-Year Evaluation of Mandatory Bundled Payments for Joint ReplacementValue-Based Health Care Meets Cost-Effectiveness AnalysisJoel Tsevat, MD, MPH and Christopher Moriates, MD 15 May 2018Volume 168, Issue 10Page: 735-736KeywordsDisclosureHealth careHealth care qualityJoint replacement surgeryLower back painMedicareMotivationQuality of lifeSurgeryTotal knee replacement ePublished: 10 April 2018 Issue Published: 15 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...