Although morbidity and the need for revisional surgery are high, the artificial bowel sphincter can improve anal incontinence and quality of life in patients with severe fecal incontinence.

Patients with abscesses smaller than 3 cm in size can be treated with antibiotics alone and, in some cases, as outpatients, and may not uniformly require surgery. This is also likely true for patients with abscesses 3-4 cm in size, although our results in this group were limited by a small sample size. Patients with abscesses larger than or equal to 4 cm can be managed with CT-guided abscess drainage followed by referral for surgical treatment.

In this retrospective study of Medicare patients, we learned that bowel obstruction, adhesiolysis for obstructions, and additional abdominal surgery occurred more often after abdominal surgery than was previously published.

Previous surgery and the presence of adhesions add significant time to opening the abdomen.

Recommendation 3.1: Population-based payment models should use outcomebased population health measures and risk adjustment systems that are designed to support population-specific and community-specific priorities for prevention and health promotion.Recommendation 3.2: If a payment model is based on measures of value that use annual measures of spending, high-value preventive services with multi-year benefits should be paid for through a separate payment mechanism or budget in order to facilitate patient access to the services, to protect against underuse of services, and to enable flexibility in the way preventive services are delivered. 7 Recommendation 6.1: A clinician or other healthcare provider who is taking accountability under an alternative payment model for improving the quality of care for a patient and for controlling the cost of the patient's care should have the flexibility to design or redesign cost-sharing requirements for the patient where necessary to enable and encourage the patient to adhere to a care plan developed through a shared decision-making process.Recommendation 6.2: Providers should be transparent about the quality of care they deliver so that patients can be assured that they are receiving high-quality care under value-based payment systems and benefit designs. Data and Analyses Needed to Develop and Implement Successful Payment ModelsRecommendation 7.1: Data on all of the important clinical and non-clinical factors that can have a significant impact on patient needs and outcomes must be accessible in order to support development and use of valid and reliable risk stratification methodologies in performance measures and alternative payment models.Recommendation 7.2: Linkages must be developed between the information in claims data, the information in electronic health records and registries, and information on patient-reported outcomes in order to provide the analyses needed to improve care and measure performance. Funding should be provided to enable Qualified Entities (which have multi-payer claims data), Qualified Clinical Data Registries (which collect clinical information relating to patient care), and Patient-8 Reported Outcome databases to link their data for specific uses that will benefit patients, payers, and providers and that incorporate appropriate protections to ensure responsible use.Recommendation 7.3: All Electronic Health Record systems should be required to support (a) the creation of custom fields and (b) data retrieval and analysis. Incentives should be created to encourage the development of infrastructure for linking data and there should be penalties for vendors that block data.Recommendation 7.4: Payers and provider organizations should be required to give clinicians access to information on the amounts payers and patients pay for services. Facilitating the Transition to Improved Payment SystemsRecommendation 8.1: Alternative payment models should be implemented using multi-year contracts and/or multi-year performance measures that allow for a shortterm peri...