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Journal articles on the topic 'Payment of care'

Author: Grafiati

Published: 9 September 2021

Last updated: 29 July 2025

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1

Neprash, Hannah T., Ezra Golberstein, Ishani Ganguli, and Michael E. Chernew. "Association of Evaluation and Management Payment Policy Changes With Medicare Payment to Physicians by Specialty." JAMA 329, no. 8 (2023): 662. http://dx.doi.org/10.1001/jama.2023.0879.

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ImportanceUS primary care physicians (PCPs) have lower mean incomes than specialists, likely contributing to workforce shortages. In 2021, the Centers for Medicare &amp;amp; Medicaid Services increased payment for evaluation and management (E/M) services and relaxed documentation requirements. These changes may have reduced the gap between primary care and specialist payment.ObjectivesTo simulate the effect of the E/M payment policy change on total Medicare physician payments while holding volume constant and to compare these simulated changes with observed changes in total Medicare paymen

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Brown, Kelby, Nada El Husseini, Rohan Grimley, et al. "Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review." Stroke 53, no. 1 (2022): 268–78. http://dx.doi.org/10.1161/strokeaha.121.033983.

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Stroke contributes an estimated $28 billion to US health care costs annually, and alternative payment models aim to improve outcomes and lower spending over fee-for-service by aligning economic incentives with high value care. This systematic review evaluates historical and current evidence regarding the impacts of alternative payment models on stroke outcomes, spending, and utilization. Included studies evaluated alternative payment models in 4 categories: pay-for-performance (n=3), prospective payments (n=14), shared savings (n=5), and capitated payments (n=14). Pay-for-performance models we

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Omelyanovskiy, V. V., N. N. Sisigina, V. K. Fedyaeva, and N. Z. Musina. "Evolution of healthcare provider payment mechanisms." FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology 12, no. 4 (2020): 318–26. http://dx.doi.org/10.17749/2070-4909.2019.12.4.318-326.

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Methods of payment to care providers constitute an essential part of the healthcare financing system; these mechanisms determine the motivation of service providers. Throughout the history of public health care, the payment methods have been gradually improved so to stimulate the providers to best match the societal demands (greater access to health services, cost reduction, and better quality) and prevent “moral hazards”. As a result, the most advanced healthcare systems have stopped paying simply for service volume and rigorously restraining the costs. Instead, the updated system is based on

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Hines, Kevin, Nikolaos Mouchtouris, Charles Getz, et al. "Bundled Payment Models in Spine Surgery." Global Spine Journal 11, no. 1_suppl (2021): 7S—13S. http://dx.doi.org/10.1177/2192568220974977.

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Study Design: The following is a narrative discussion of bundled payments in spine surgery. Objective: The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery. Methods: Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts. Results: Spine surgery is challenging to define payment modes becau

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Lewis, Charles G. "Payment for care." Journal of the American Dental Association 116, no. 7 (1988): 818. http://dx.doi.org/10.14219/jada.archive.1988.0290.

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Edwards, Samuel T., and Bruce E. Landon. "Medicare's Chronic Care Management Payment — Payment Reform for Primary Care." New England Journal of Medicine 371, no. 22 (2014): 2049–51. http://dx.doi.org/10.1056/nejmp1410790.

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Vengberg, Sofie, Mio Fredriksson, Bo Burström, Kristina Burström, and Ulrika Winblad. "Money matters – primary care providers' perceptions of payment incentives." Journal of Health Organization and Management 35, no. 4 (2021): 458–74. http://dx.doi.org/10.1108/jhom-06-2020-0225.

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PurposePayments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work.Design/methodology/approachAn interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjuste

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Navathe, Amol S., Claire Dinh, Sarah E. Dykstra, Rachel M. Werner, and Joshua M. Liao. "Overlap between Medicare’s Voluntary Bundled Payment and Accountable Care Organization Programs." Journal of Hospital Medicine 15, no. 6 (2019): 356–58. http://dx.doi.org/10.12788/jhm.3288.

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Accountable care organizations (ACOs) and bundled payments represent prominent value-based payment models, but the magnitude of overlap between the two models has not yet been described. Using Medicare data, we defined overlap based on attribution to Medicare Shared Savings Program (MSSP) ACOs and hospitalization for Bundled Payments for Care Improvement (BPCI) episodes at BPCI participant hospitals. Between 2013 and 2016, overlap as a share of ACO patients increased from 2.7% to 10% across BPCI episodes, while overlap as a share of all bundled payment patients increased from 19% to 27%. Overl

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Wise, Sarah, Jane Hall, Philip Haywood, Nikita Khana, Lutfun Hossain, and Kees van Gool. "Paying for value: options for value-based payment reform in Australia." Australian Health Review 46, no. 2 (2021): 129–33. http://dx.doi.org/10.1071/ah21115.

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Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of ‘low-value’ interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical f

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Yang, Wei. "UNDERSTANDING NON-MEDICAL COSTS FOR HEALTH CARE: EVIDENCE FROM INPATIENT CARE FOR OLDER PEOPLE IN CHINA." Innovation in Aging 3, Supplement_1 (2019): S733. http://dx.doi.org/10.1093/geroni/igz038.2686.

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Abstract Non-medical costs can constitute a substantial part of total health care costs, especially for older people. Costs associated with carers, travel, food and accommodation for family members accompanying and caring for older people during their medical visits can be hefty. This study seeks to examine the effects of non-medical costs on catastrophic health payments and health payment-induced poverty among older people in rural and urban China. Using data from the China Health and Retirement Longitudinal Survey 2015, this study finds that inpatient costs account for a significant proporti

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Miller, Edward, John Bowblis, Elizabeth Simpson, et al. "FEDERAL AND STATE POLICIES AND STAKEHOLDER VIEWS ON MEDICAID NURSING HOME PAYMENT." Innovation in Aging 8, Supplement_1 (2024): 611. https://doi.org/10.1093/geroni/igae098.2002.

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Abstract How much nursing homes (NHs) are paid by Medicaid is determined at the state level. Medicaid coverage of NH care is a significant expenditure for states. Consequently, states design Medicaid payment models to achieve desired policy objectives related to NH costs and quality, access to care, payment equity, service capacity, and budgetary control. Setting Medicaid payment rates too high can lead to excess profits at the expense of taxpayers with unknown implications to improvements in quality and staffing levels. At the same time, NHs need financial resources to pay nursing staff and i

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Ash, Arlene S., Matthew J. Alcusky, Randall P. Ellis, Meagan J. Sabatino, Frances E. Eanet, and Eric O. Mick. "Supporting Primary Care for Medically and Socially Complex Patients in Medicaid Managed Care." JAMA Network Open 8, no. 2 (2025): e2458170. https://doi.org/10.1001/jamanetworkopen.2024.58170.

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ImportanceIn 2023, the Massachusetts Medicaid and Children’s Health Insurance Program (MassHealth) required accountable care organizations (ACOs) to increase payments to primary care practices and shift to monthly payments, currently calibrated to historical revenues and enhanced practice capabilities, such as being staffed to address behavioral health needs. To prevent rewarding practices for avoiding difficult patients, future payments to primary care practices should reflect their patients’ apparent need.ObjectiveTo describe MassHealth’s initiative and a complexity-adjusted payment model.De

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Spinks, Tracy, Alexis Guzman, Beth M. Beadle, et al. "Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program." Journal of Oncology Practice 14, no. 2 (2018): e103-e112. http://dx.doi.org/10.1200/jop.2017.027029.

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Purpose: Despite growing interest in bundled payments to reduce the costs of care, this payment method remains largely untested in cancer. This 3-year pilot tested the feasibility of a 1-year bundled payment for the multidisciplinary treatment of head and neck cancers. Methods: Four prospective treatment-based bundles were developed for patients with selected head and neck cancers. These risk-adjusted bundles covered 1 year of care that began with primary cancer treatment. Manual processes were developed for patient identification, enrollment, billing, and payment. Patients were prospectively

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Mousavi, Batool, Farzaneh Maftoon, Mohammadreza Soroush, Kazem Mohammad, and Reza Majdzadeh. "Health Care Utilization and Expenditure in War Survivors." Archives of Iranian Medicine 23, no. 4Suppl1 (2020): S9—S15. http://dx.doi.org/10.34172/aim.2020.s3.

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Background: To describe the utilization and out-of-pocket (OOP) payments of war survivors receiving health care services and its determinants. Methods: A cross-sectional study was carried out by systematic random sampling at national level (n = 3079) on healthcare utilization in war survivors on their last received services. A validated questionnaire was used to gather the information of inpatient and outpatient healthcare services and OOP payment. The data were analyzed to indicate the determinants of health utilization and expenses. Results: Health care utilization was reported in 91.6% (n =

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Kahn, Elyne N., Chandy Ellimoottil, James M. Dupree, Paul Park, and Andrew M. Ryan. "115 Variation in Payments for Spine Surgery Episodes of Care: Implications for Episode-Based Bundled Payment." Neurosurgery 64, CN_suppl_1 (2017): 224. http://dx.doi.org/10.1093/neuros/nyx417.115.

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Abstract INTRODUCTION Spine surgery is expensive and marked by high variation across regions and providers. Bundled payments have potential to reduce unwarranted spending associated with spine surgery. We sought to quantify variation in spine surgery payments, document sources of variation, and determine the influence of patient-level, surgeon-level, and hospital-level factors on payment variation. METHODS Cross-sectional analysis of commercial and Medicare claims data from January 2012 through March 2015 in the state of Michigan. Participants were adult patients who underwent spine-based surg

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Ward, Jeffrey C., Brian Bourbeau, Alexander L. Chin, et al. "Updates to the ASCO Patient-Centered Oncology Payment Model." JCO Oncology Practice 16, no. 5 (2020): 263–69. http://dx.doi.org/10.1200/jop.19.00776.

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The past decade has seen considerable innovation in the delivery of care and payment in oncology. Key initiatives have included the development of oncology medical home care delivery standards, the Medicare Oncology Care Model, and multiple commercial payer initiatives. Looking forward, our next challenge is to reflect on lessons learned from these limited-scale demonstration projects and work toward models that are scalable and sustainable and reflect true collaboration between payers and providers sharing common objectives and methods to advance cancer care delivery. To this end, ASCO contin

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Hobbs Knutson, Katherine. "Payment for Integrated Care." Child and Adolescent Psychiatric Clinics of North America 26, no. 4 (2017): 829–38. http://dx.doi.org/10.1016/j.chc.2017.06.010.

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Kanters, Arielle E., and Chad Ellimoottil. "Bundled care payment models." Seminars in Colon and Rectal Surgery 29, no. 2 (2018): 60–63. http://dx.doi.org/10.1053/j.scrs.2018.01.004.

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Buligescu, Bianca, and Henry Espinoza Peňa. "Informal payments in Romanian health care system. A sample selection correction." Sociologie Romaneasca 18, no. 2 (2020): 40–73. http://dx.doi.org/10.33788/sr.18.2.2.

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This paper draws on economic theory, sociology and political science approaches to explain informal payments in the Romanian health care system. It estimates the likelihood of paying a bribe (informal payment) using a reduced health care demand equation in a probit model with sample selection correction. Social capital, as having a relationship with doctors, and the perception of the health care system, as corrupt, are found to influence the probability of making an informal payment. The likelihood of making an informal payment in the Romanian health care system is modelled using a maximum-lik

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McClellan, Mark. "Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality?" Journal of Economic Perspectives 25, no. 2 (2011): 69–92. http://dx.doi.org/10.1257/jep.25.2.69.

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This paper focuses on a broad movement toward a fundamentally different way of paying healthcare providers. The approach reaches beyond the old dichotomies about whether healthcare providers are reimbursed on a fee-for-service or a “capitated” or per-person payment. Instead, these reforms seek to create direct linkages between payments to healthcare providers and measures of the quality and efficiency of care. After an overview of payment reforms for healthcare providers and their welfare implications, this paper discusses a range of empirical studies. These often small-scale studies suggest t

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Cabral, Marika, Colleen Carey, and Sarah Miller. "The Impact of Provider Payments on Health Care Utilization of Low-Income Individuals: Evidence from Medicare and Medicaid." American Economic Journal: Economic Policy 17, no. 1 (2025): 106–43. https://doi.org/10.1257/pol.20220775.

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Provider payments are the key determinant of insurance generosity within many health insurance programs covering low-income populations. This paper analyzes a large, federally mandated provider payment increase for primary care services provided to low-income elderly and disabled individuals. Using comprehensive administrative data, we leverage variation across beneficiaries and providers in the policy-induced payment increase in difference-in-differences and triple differences research designs. We find the payment increase led to a 6 percent increase in the targeted services for eligible bene

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Wang, Virginia, Shailender Swaminathan, Emily A. Corneau, et al. "Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD." Clinical Journal of the American Society of Nephrology 15, no. 11 (2020): 1631–39. http://dx.doi.org/10.2215/cjn.02100220.

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Background and objectivesBecause of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011—when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care—payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans’ access

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Helmchen, Lorens A., William E. Encinosa, Michael E. Chernew, and Richard A. Hirth. "Integrating Patient Incentives with Episode-Based Payment." Forum for Health Economics and Policy 16, no. 1 (2013): 123–36. http://dx.doi.org/10.1515/fhep-2012-0002.

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Abstract To rein in cost, payers are exploring bundled payment, which aggregates fees for a range of services into a single prospective payment. While under bundled payment providers would have incentives to reduce cost, they might also withhold more expensive care that patients prefer. We explore how bundled payment could be aligned with a benefit design that would encourage patients’ consideration of cost without jeopardizing access to the most expensive treatments. Least-costly-alternative approaches allow patient choice but might deter patients from choosing more expensive care by exposing

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Hirsch, Joshua A., Thabele M. Leslie-Mazwi, Robert M. Barr, et al. "The Burwell roadmap." Journal of NeuroInterventional Surgery 8, no. 5 (2015): 544–46. http://dx.doi.org/10.1136/neurintsurg-2015-011706.

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In January 2015 the current Secretary of the Department of Health and Human Services (HHS) outlined a bold initiative to shape the delivery of healthcare through a set of strategies aimed at improving the quality of care and reducing the growth of healthcare costs. The strategies include increasing payment incentives tied to higher value care, increasing care coordination and integration, and increasing access to information to guide patients and clinicians. Significantly, the proposal includes specific goals for alternative payment models and value-based payments for the first time in the his

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Yang, Wei. "Understanding the Non-medical Costs of Healthcare: Evidence from Inpatient Care for Older People in China." China Quarterly 242 (September 16, 2019): 487–507. http://dx.doi.org/10.1017/s0305741019001115.

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AbstractNon-medical costs, including costs associated with carers, travel, food and accommodation for family members who care for older people during their medical visits, can constitute a substantial part of total healthcare costs, especially for older people. Using data from the 2015 China Health and Retirement Longitudinal Survey, this study examines the effects of such non-medical costs on catastrophic health payments and health payment-induced poverty among older people in China. Results indicate that non-medical costs account for approximately 18 per cent of total inpatient costs. The pe

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Landon, Bruce E., and David H. Roberts. "Reenvisioning Specialty Care and Payment Under Global Payment Systems." JAMA 310, no. 4 (2013): 371. http://dx.doi.org/10.1001/jama.2013.75247.

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Goroll, Allan H., Robert A. Berenson, Stephen C. Schoenbaum, and Laurence B. Gardner. "Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care." Journal of General Internal Medicine 22, no. 3 (2007): 410–15. http://dx.doi.org/10.1007/s11606-006-0083-2.

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Delisle, Dennis R. "Republished: Big Things Come in Bundled Packages: Implications of Bundled Payment Systems in Health Care Reimbursement Reform." American Journal of Medical Quality 34, no. 5 (2019): 482–87. http://dx.doi.org/10.1177/1062860619873220.

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With passage of the Affordable Care Act, the ever-evolving landscape of health care braces for another shift in the reimbursement paradigm. As health care costs continue to rise, providers are pressed to deliver efficient, high-quality care at flat to minimally increasing rates. Inherent systemwide inefficiencies between payers and providers at various clinical settings pose a daunting task for enhancing collaboration and care coordination. A change from Medicare’s fee-for-service reimbursement model to bundled payments offers one avenue for resolution. Pilots using such payment models have re

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Manchikanti, Laxmaiah. "Facility Payments for Interventional Pain Management Procedures: Impact of Proposed Rules." Pain Physician 7;19, no. 7;9 (2016): E957—E984. http://dx.doi.org/10.36076/ppj/2016.19.e957.

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In the face of the progressive implementation of the Affordable Care Act (ACA), a significant regulatory regime, and the Merit-Based Incentive Payment System (MIPS), the Centers for Medicare and Medicaid Services (CMS) released its proposed 2017 hospital outpatient department (HOPD) and ambulatory surgery center (ASC) payment rules on July 14, 2016, and the physician payment schedule was released July 15, 2016. U.S. health care costs continue to increase, occupying 17.5% of the gross domestic product (GDP) in 2014 and surpassing $3 trillion in overall health care expenditure. Solo and independ

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Bour, Sterre S., Lena H. A. Raaijmakers, Erik W. M. A. Bischoff, Lucas M. A. Goossens, and Maureen P. M. H. Rutten-van Mölken. "How Can a Bundled Payment Model Incentivize the Transition from Single-Disease Management to Person-Centred and Integrated Care for Chronic Diseases in the Netherlands?" International Journal of Environmental Research and Public Health 20, no. 5 (2023): 3857. http://dx.doi.org/10.3390/ijerph20053857.

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To stimulate the integration of chronic care across disciplines, the Netherlands has implemented single-disease management programmes (SDMPs) in primary care since 2010; for example, for COPD, type 2 diabetes mellitus, and cardiovascular diseases. These disease-specific chronic care programmes are funded by bundled payments. For chronically ill patients with multimorbidity or with problems in other domains of health, this approach was shown to be less fit for purpose. As a result, we are currently witnessing several initiatives to broaden the scope of these programmes, aiming to provide truly

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Girault, Anne, Chloe Gerves-Pinquie, and Etienne Minvielle. "Designing and implementing a payment system to support cancer care coordination: A literature review." Journal of Clinical Oncology 34, no. 7_suppl (2016): 40. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.40.

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40 Background: Demands for new payment systems to better coordinate services along the care continuum are emerging in oncology. Among them, bundling payments for defined episodes of care are considered as a promising payment option. The study objective was to understand how to develop an optimal payment system in order to foster coordination between hospitals and post-acute providers, and to identify potential pitfalls associated with its implementation. Methods: We conducted a literature review, exploring articles published between 2010 and 2015 in Medline. 47 papers were finally retrieved, i

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WOOLHAM, JOHN, GUY DALY, TIM SPARKS, KATRINA RITTERS, and NICOLE STEILS. "Do direct payments improve outcomes for older people who receive social care? Differences in outcome between people aged 75+ who have a managed personal budget or a direct payment." Ageing and Society 37, no. 5 (2016): 961–84. http://dx.doi.org/10.1017/s0144686x15001531.

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ABSTRACTDirect payments – cash for people eligible for adult social care and spent by them on care and support – are claimed to enable care to better reflect user preferences and goals which improve outcomes. This paper compares outcomes of older direct payment users and those receiving care via a managed personal budget (where the budget is spent on the recipients behalf by a third party). The study adopted a retrospective, comparative design using a postal questionnaire in three English councils with adult social care responsibilities in 2012–13. Included in the study were 1,341 budget users

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Patel, Kavita K., Alexander J. Morin, Jeffrey L. Nadel, and Mark B. McClellan. "Meaningful Physician Payment Reform in Oncology." Journal of Oncology Practice 9, no. 6S (2013): 49s—53s. http://dx.doi.org/10.1200/jop.2013.001248.

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The authors describe various new models of physician payment that can serve as a foundation for a shift away from the current reimbursement system for cancer care to support better outcomes and avoid preventable costs, as well as how these reforms can be supported in a blended payment model that transitions away from but still contains elements of fee-for-service payments.

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Cattel, Daniëlle, Frank Eijkenaar, and Frederik T. Schut. "Value-based provider payment: towards a theoretically preferred design." Health Economics, Policy and Law 15, no. 1 (2018): 94–112. http://dx.doi.org/10.1017/s1744133118000397.

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AbstractWorldwide, policymakers and purchasers are exploring innovative provider payment strategies promoting value in health care, known as value-based payments (VBP). What is meant by ‘value’, however, is often unclear and the relationship between value and the payment design is not explicated. This paper aims at: (1) identifying value dimensions that are ideally stimulated by VBP and (2) constructing a framework of a theoretically preferred VBP design. Based on a synthesis of both theoretical and empirical studies on payment incentives, we conclude that VBP should consist of two components:

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Kwon, Jinhee, Eun-Jeong Han, and Hyun Ki Kim. "An analysis of the efffects of the income level of the family caregivers for the recipients using LTC home care services on the willingness to pay : A cross-sectional study." Journal of Korean Gerontological Nursing 26, no. 4 (2024): 413–22. https://doi.org/10.17079/jkgn.2024.00437.

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Purpose: This study aimed to determine how income level affects the willingness to pay out-of-pocket payments for those who bear the cost of home care services to use better services. Method: We analyzed data from 1,189 family caregivers who used home care services in the Co-payment for LTC Insurance in 2021. The Chi-square and Cochran-Mantel-haenszel tests was conducted to confirm the relationship between the family caregiver’s income level and willingness to pay out-of-pocket payments. The logistic regression analysis was performed to analyze the effect of income level on willingness to pay.

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Ghazaryan, Emma, Benjo A. Delarmente, Kent Garber, Margaret Gross, Salin Sriudomporn, and Krishna D. Rao. "Effectiveness of hospital payment reforms in low- and middle-income countries: a systematic review." Health Policy and Planning 36, no. 8 (2021): 1344–56. http://dx.doi.org/10.1093/heapol/czab050.

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Abstract Payment mechanisms have attracted substantial research interest because of their consequent effect on care outcomes, including treatment costs, admission and readmission rates and patient satisfaction. Those mechanisms create the incentive environment within which health workers operate and can influence provider behaviour in ways that can facilitate achievement of national health policy goals. This systematic review aims to understand the effects of changes in hospital payment mechanisms introduced in low- and middle-income countries (LMICs) on hospital- and patient-level outcomes. A

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Stone, John R. "Non-Payment and Non-Care." Medical Care 48, no. 6 (2010): 495–97. http://dx.doi.org/10.1097/mlr.0b013e3181e1c330.

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KRUPA, JUDITH A. "Denying Care Versus Denying Payment." Nursing Management (Springhouse) 30, no. 3 (1999): 10???11. http://dx.doi.org/10.1097/00006247-199903000-00003.

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39

Sonenberg, Andréa, and Alsacia L. Sepulveda-Pacsi. "Medicare Payment: Advanced Care Planning." Journal for Nurse Practitioners 14, no. 2 (2018): 112–16. http://dx.doi.org/10.1016/j.nurpra.2017.11.023.

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40

Piccinin, Meghan A., Zain Sayeed, Ryan Kozlowski, Vamsy Bobba, David Knesek, and Todd Frush. "Bundle Payment for Musculoskeletal Care." Orthopedic Clinics of North America 49, no. 2 (2018): 135–46. http://dx.doi.org/10.1016/j.ocl.2017.11.002.

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Piccinin, Meghan A., Zain Sayeed, Ryan Kozlowski, Vamsy Bobba, David Knesek, and Todd Frush. "Bundle Payment for Musculoskeletal Care." Orthopedic Clinics of North America 49, no. 2 (2018): 147–56. http://dx.doi.org/10.1016/j.ocl.2017.11.003.

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42

Palumbo, Francis B. "Pharmaceutical Care and Payment Reform." American Pharmacy 34, no. 9 (1994): 4. http://dx.doi.org/10.1016/s0160-3450(15)30079-9.

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43

Zillich, Alan J., and Karen Blumenschein. "Letter: Payment for Pharmaceutical Care?" Journal of the American Pharmaceutical Association (1996) 41, no. 1 (2001): 4–8. http://dx.doi.org/10.1016/s1086-5802(16)31216-5.

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44

Khullar, Dhruv. "Payment, Priorities, and Primary Care." JAMA 329, no. 8 (2023): 635. http://dx.doi.org/10.1001/jama.2023.0880.

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Clemens, Jeffrey, and Joshua D. Gottlieb. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?" American Economic Review 104, no. 4 (2014): 1320–49. http://dx.doi.org/10.1257/aer.104.4.1320.

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We investigate whether physicians' financial incentives influence health care supply, technology diffusion, and resulting patient outcomes. In 1997, Medicare consolidated the geographic regions across which it adjusts physician payments, generating area-specific price shocks. Areas with higher payment shocks experience significant increases in health care supply. On average, a 2 percent increase in payment rates leads to a 3 percent increase in care provision. Elective procedures such as cataract surgery respond much more strongly than less discretionary services. Non-radiologists expand their

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Hung, Man, Jerry Bounsanga, Maren W. Voss, and Jeremy D. Franklin. "Medicare Part B Status among Orthopaedic Surgery Providers in the United States." Journal of Health and Human Services Administration 41, no. 2 (2018): 126–52. http://dx.doi.org/10.1177/107937391804100201.

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Health care delivery often focuses on treatments over provider and payment attributes, which also impact care delivery. This study describes the procedures, allowed charges, submitted charges, and payments for orthopaedic providers that accept Medicare Part B in the US. Additionally, the study investigated regional and gender differences in charges and payments. We used the national Medicare Part B Provider Utilization and Payment data released from the CMS in April 2014. Analyses were conducted on US providers that identified as orthopaedic surgeons. There was a major gender disparity in orth

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Du, Tiantian, Junting Yang, Ying Li, Meng Zhang, and Yuehua Liu. "PP548 The Design Of Long-term Care Insurance Payment: Base On Pilot Practice In Jingmen." International Journal of Technology Assessment in Health Care 36, S1 (2020): 41–42. http://dx.doi.org/10.1017/s0266462320001993.

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IntroductionWith the aging of population, miniaturization of family size and changes of diseases spectrum, the demand for long-term care of Chinese elderly is increasing, which is challenging the existing long-term care system. China is currently carrying out pilot work for a long-term care insurance system, and Jingmen is one of the pilot cities, however more detailed research on payment is needed. Therefore, this paper draws on case-mixed-adjusted prospective payment system to provide designs for long-term care insurance in pilot cities.MethodsAdopting a case analysis method, this paper focu

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Cattel, Daniëlle, and Frank Eijkenaar. "Value-Based Provider Payment Initiatives Combining Global Payments With Explicit Quality Incentives: A Systematic Review." Medical Care Research and Review 77, no. 6 (2019): 511–37. http://dx.doi.org/10.1177/1077558719856775.

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An essential element in the pursuit of value-based health care is provider payment reform. This article aims to identify and analyze payment initiatives comprising a specific manifestation of value-based payment reform that can be expected to contribute to value in a broad sense: (a) global base payments combined with (b) explicit quality incentives. We conducted a systematic review of the literature, consulting four scientific bibliographic databases, reference lists, the Internet, and experts. We included and compared 18 initiatives described in 111 articles/documents on key design features

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Manchikanti, Laxmaiah. "Proposed Medicare Physician Payment Schedule for 2017: Impact on Interventional Pain Management Practices." Pain Physician 7;19, no. 7;9 (2016): E935—E955. http://dx.doi.org/10.36076/ppj/2016.19.e935.

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The Centers for Medicare and Medicaid Services (CMS) released the proposed 2017 Medicare physician fee schedule on July 7, 2016, addressing Medicare payments for physicians providing services either in an office or facility setting, which also includes payments for office expenses and quality provisions for physicians. This proposed rule occurs in the context of numerous policy changes, most notably related to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and its Merit-Based Incentive Payment System (MIPS). The proposed rule affects interventional pain management specialis

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Wodowski, A. J., C. E. Pelt, J. A. Erickson, M. B. Anderson, J. M. Gililland, and C. L. Peters. "‘Bundle busters’." Bone & Joint Journal 101-B, no. 7_Supple_C (2019): 64–69. http://dx.doi.org/10.1302/0301-620x.101b7.bjj-2018-1522.r1.

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Aims The Bundled Payments for Care Improvement (BPCI) initiative has identified pathways for improving the value of care. However, patient-specific modifiable and non-modifiable risk factors may increase costs beyond the target payment. We sought to identify risk factors for exceeding our institution’s target payment, the so-called ‘bundle busters’. Patients and Methods Using our data warehouse and Centers for Medicare and Medicaid Services (CMS) data we identified all 412 patients who underwent total joint arthroplasty and qualified for our institution’s BPCI model, between July 2015 and May

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