Alternative payment models and urology

Kaye, Deborah R.; Miller, David C.; Ellimoottil, Chad

doi:10.1097/mou.0000000000000403

Cited by 9 publications

(6 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As Medicare continues to move away from volume‐based fee‐for‐service and to link reimbursement to value‐oriented targets, eligible health care providers are expected to enter into either MIPS or an alternative payment model, such as an accountable care organization or bundled payment . Under MIPS, physician reimbursement is tied to a Composite Performance Score based on 4 categories of performance, which include quality and resource use.…”

Section: Discussionmentioning

confidence: 99%

“…As Medicare continues to move away from volume-based fee-for-service and to link reimbursement to value-oriented targets, eligible health care providers are expected to enter into either MIPS or an alternative payment model, such as an accountable care organization or bundled payment. 38,39 Under MIPS, physician reimbursement is tied to a Composite Performance Score based on 4 categories of performance, which include quality and resource use. Current prostate cancer quality indicators target the use of imaging for low-risk patients, although our results suggest that it may also be productive to target variation in radiotherapy under the MIPS program.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Physician and facility drivers of spending variation in locoregional prostate cancer

Rodin

Chien

Ellimoottil

et al. 2020

Cancer

Self Cite

View full text Add to dashboard Cite

Background Prostate cancer is the most common male cancer, with a wide range of treatment options. Payment reform to reduce unnecessary spending variation is an important strategy for reducing waste, but its magnitude and drivers within prostate cancer are unknown. Methods In total, 38,971 men aged ≥66 years with localized prostate cancer who were enrolled in Medicare fee‐for‐service and were included in the Surveillance, Epidemiology, and End Results‐Medicare database from 2009 to 2014 were included. Multilevel linear regression with physician and facility random effects was used to examine the contributions of urologists, radiation oncologists, and their affiliated facilities to variation in total patient spending in the year after diagnosis within geographic region. The authors assessed whether spending variation was driven by patient characteristics, disease risk, or treatments. Physicians and facilities were sorted into quintiles of adjusted patient‐level spending, and differences between those that were high‐spending and low‐spending were examined. Results Substantial variation in spending was driven by physician and facility factors. Differences in cancer treatment modalities drove more variation across physicians than differences in patient and disease characteristics (72% vs 2% for urologists, 20% vs 18% for radiation oncologists). The highest spending physicians spent 46% more than the lowest and had more imaging tests, inpatient care, and radiotherapy spending. There were no differences across spending quintiles in the use of robotic surgery by urologists or the use of brachytherapy by radiation oncologists. Conclusions Significant differences were observed for patients with similar demographics and disease characteristics. This variation across both physicians and facilities suggests that efforts to reduce unnecessary spending must address decision making at both levels.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Physician and facility drivers of spending variation in locoregional prostate cancer

Rodin

Chien

Ellimoottil

et al. 2020

Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…In an era of ongoing healthcare reform, bundled care is among the proposed strategies to improve value and is being actively explored in selected settings. 27 By providing global reimbursement for a procedure and associated perioperative care, provider incentives are better aligned with quality; that is, limiting perioperative complications, LOS and readmissions. Hence, differentiating modifiable and nonmodifiable factors affecting these outcomes will be critical for patients, providers and healthcare systems.…”

Section: Discussionmentioning

confidence: 99%

The impact of patient-related nonmodifiable factors on perioperative outcomes following radical cystectomy with enhanced recovery protocol

Zainfeld

Chen

Cai

et al. 2018

Therapeutic Advances in Urology

View full text Add to dashboard Cite

Background:Enhanced recovery after surgery (ERAS) protocols decrease the length of hospital stay (LOS) and complications following radical cystectomy (RC). However, the impact of non-modifiable patient factors to postoperative outcome is unclear. This study aimed to identify nonmodifiable patient and disease factors predictive of post-RC outcomes with ERAS protocols.Methods:We reviewed our institutional review board-approved prospectively maintained bladder cancer database. Patients with primary urothelial bladder cancer who underwent open RC with ERAS protocol between 2012 and 2016 were identified. Patient demographic and disease-relevant variables were reviewed. Factors predictive of LOS, 30- and 90-day complications and readmission were assessed using univariate and multivariable analyses.Results:A total of 289 patients with a median age of 70 years were included, of whom 80.6% were male, 33.6% had Charlson comorbidity index ⩾2. Median LOS was 4 days and 21.1% received intraoperative transfusion. The 30-day complication and readmission rates were 58.8% and 16.6%, respectively. Age >70 (p = 0.02), Charlson comorbidity index ⩾2 (p = 0.005), and intraoperative transfusion (p = 0.03) were significantly associated with LOS. Intraoperative transfusion was significantly associated with 30-day complication and readmission (p = 0.008, p = 0.005, respectively). No factor was found to be significantly associated with 90-day complication or readmission.Conclusions:With ERAS protocol, non-modifiable patient and disease factors influence outcomes after RC. Risk adjustment for these factors is important for patient counseling, quality assessment and future reimbursement.

show abstract

“…For example, multiple medical specialists including urologists, gastroenterologists and orthopedists have begun chronicling the movement and emphasis of value over volume. 6 – 9 More specifically, the Merit Based Incentive Payment System (MIPS) is also being discussed by specialist communities. 10 …”

Section: Reimbursement Changes Taking Place Outside Of Oandpmentioning

confidence: 99%

Contemplating Health Economics, Coding and Reimbursement in Orthotics, Prosthetics and Pedorthics

Highsmith

Fantini

Smith

2021

Can. Prosthet. Orthot. J.

View full text Add to dashboard Cite

Reimbursement to U.S. healthcare service providers is largely transitioning from fee for service to fee for value for those clinicians who code using current procedural terminology and through their coding, describe their professional services. The Orthotic, Prosthetic and Pedorthic profession (O&P), currently codes using a system that describes the devices they evaluate for, fabricate, fit and maintain and their professional services are incorporated into their codes. These O&P codes, in contrast to those for other healthcare disciplines, are predominantly product based rather than service based, focusing on product features and function more than clinical service. This editorial manuscript provides a brief overview of the system the US O&P profession uses currently, particularly in the context of other healthcare professions transitioning to value based coding and reimbursement and culminates in a call to action for the profession to academically consider the strengths and weaknesses of the current system relative to alternative systems. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36125/28316 How To Cite: Highsmith MJ, Fantini CM, Smith DG. Contemplating health economics, coding and reimbursement in orthotics, prosthetics and pedorthics. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.5. https://doi.org/10.33137/cpoj.v4i2.36125 Corresponding Author: M. Jason Highsmith, PhD, DPT, CP, FAAOPSchool of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida. Florida, USA.E-Mail: mhighsmi@usf.eduORCID ID: https://orcid.org/0000-0001-8361-7345

show abstract

Alternative payment models and urology

Cited by 9 publications

References 3 publications

Physician and facility drivers of spending variation in locoregional prostate cancer

Physician and facility drivers of spending variation in locoregional prostate cancer

The impact of patient-related nonmodifiable factors on perioperative outcomes following radical cystectomy with enhanced recovery protocol

Contemplating Health Economics, Coding and Reimbursement in Orthotics, Prosthetics and Pedorthics

Contact Info

Product

Resources

About