Health Care Reform

Britt, L. D.; Hoyt, David B.; Jasak, Robert; Jones, R. Scott; Drapkin, Jacob

doi:10.1097/sla.0b013e3182a507de

Cited by 13 publications

(6 citation statements)

References 4 publications

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“…This suggests that our regional patients likely undergo surgery at their local centers for emergency care. We are unable to determine the impact and outcomes of this practice in the current study, however it will be important to understand this interaction since ACOs will require outstanding outcomes in the care of all patients in the most cost effective manner 1,22 . Future areas of research should focus on travel distance and level of care for emergency patients to define optimal management for them.…”

Section: Discussionmentioning

confidence: 95%

“…The Patient Protection and Affordable Care Act (PPACA) continues to change the delivery and finances of healthcare across the United States through three major goals 1–4 : improved access to care, improved quality of care, and decreased cost of care. These include increasing access to care through insurance reform, the control of healthcare costs and a redesign of the delivery system through payment reform and the development of Accountable Care Organizations (ACOs) 1,5 .…”

Section: Introduction and Objectivementioning

confidence: 99%

“…These include increasing access to care through insurance reform, the control of healthcare costs and a redesign of the delivery system through payment reform and the development of Accountable Care Organizations (ACOs) 1,5 . Initiated by the Center for Medicare and Medicaid Innovation (CMS), ACOs are responsible for the healthcare of an assigned patient population 6 .…”

Section: Introduction and Objectivementioning

confidence: 99%

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Access to Quaternary Care Surgery: Implications for Accountable Care Organizations

Mehaffey

Hawkins

Mullen

et al. 2017

Journal of the American College of Surgeons

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Background Accountable Care Organizations (ACO) attempt to provide the most efficient and effective care to patients within a region. We hypothesize that patients who undergo surgery closer to home have improved survival due to proximity of preoperative and post-discharge care. Study Design All (17,582) institutional American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) patients with a documented zip code and predicted risk who underwent surgery at our institution (2005–2014) were evaluated. Travel times were calculated by Google Maps, and patients were stratified by 1 hour of travel (local vs regional). Multivariable logistic regression and Cox Proportional Hazard models were used to evaluate the NSQIP risk-adjusted effects of travel time on operative morbidity, mortality, and long-term survival. Results Median travel time was 65 minutes with regional patients demonstrating significantly higher rates of ascites, hypertension, diabetes, disseminated cancer, >10% weight-loss, higher ASA, higher predicted risk of morbidity and mortality and lower functional status (all p<0.01). After adjusting for ACS NSQIP predicted risk, travel time was not significantly associated with 30-day mortality (OR 1.06, p=0.42) or any major morbidities (all p>0.05). However, survival analysis demonstrated travel time is an independent predictor of long-term mortality (OR 1.24, p<0.001) Conclusions Patients traveling farther for care at a quaternary center had higher rates of comorbidities and predicted risk of complications. Additionally, travel time predicts risk-adjusted long-term mortality, suggesting a major focus of ACOs will need to be integration of care at the periphery of their region.

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Section: Discussionmentioning

confidence: 95%

Section: Introduction and Objectivementioning

confidence: 99%

Section: Introduction and Objectivementioning

confidence: 99%

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Access to Quaternary Care Surgery: Implications for Accountable Care Organizations

Mehaffey

Hawkins

Mullen

et al. 2017

Journal of the American College of Surgeons

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“…Changes in payment structures will clearly influence how physicians practice and how care is delivered. Despite the American College of Surgeons’ (ACS) recommendation to institute potentially cost-saving medical liability reform with the passage of the ACA, no provisions were included (16). The implementation of independent panels and regulatory reforms are other ACA strategies to save money.…”

Section: Key Aspects Of the Acamentioning

confidence: 99%

“…Under the controversial inpatient Value-Based Purchasing Program (VBPP), hospitals are assessed by means of 12 clinical quality measures in 6 domains (patient and family engagement, patient safety, care coordination, population and public health, efficient use of healthcare resources, and clinical processes/effectiveness) and a composite measure of patient experience (22). The VBPP is used to decrease payments to hospital providers not meeting certain quality standards established by the CMS (16). …”

Section: Key Aspects Of the Acamentioning

confidence: 99%

The Patient Protection and Affordable Care Act

Adkinson

Chung

2014

Hand Clinics

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The Affordable Care Act is the largest and most comprehensive overhaul of the United States healthcare industry since the inception of the Medicare and Medicaid. Contained within the 10 Titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals.

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