Navigation Links
Study outlines strategies to test new payment models for health care
Date:9/29/2009

A new RAND Corporation study outlines methods that might be used to test a novel payment system for medical care that would provide doctors, hospitals and other health providers a set fee for treating an ailment such as hip replacement surgery.

Proposals to pay health providers for so-called "episodes of care" have gained momentum during the ongoing debate about national health care reform as a strategy that could both curb medical spending and improve the quality of care.

While payments based on episodes of care have been widely discussed, the approach is largely conceptual with little real world experience that might help guide the design or adoption of the strategy, according to the study published in the September/October edition of the journal Health Affairs.

Researchers from RAND Health analyzed claims information from a large group of Medicare beneficiaries and identified key issues that should be considered to help determine how to define episodes of care and identify which provider is accountable for an episode.

"While using episodes of care as the basis for payment has enormous potential, we found there are many unanswered questions that must be addressed before moving forward," said Peter Hussey, the study's lead author and a policy researcher at RAND, a nonprofit research organization. "We've identified steps that should be taken to help move from concept to implementation."

Critics of the current payment system for health care say it encourages overuse of services because physicians and others are paid separately for each procedure or test performed.

Under an episode of care approach, some or all of the services related to the management of a patient's chronic or acute medical condition would be grouped together and paid for in a lump sum. For example, public or private insurance programs might make a single payment for all of the physician, facility, and pharmacy services related to care for conditions such as implanting an artificial hip or managing a patient's diabetes.

Supporters of the strategy say it would shift the financial incentives in a way that would encourage providers to eliminate unnecessary procedures and tests, as well as promoting the best quality care to help patients stay healthy or recover quickly.

The RAND study highlights some of the challenges that must be overcome in designing a program to test the utility of paying for medical care based on episodes of care.

Among those challenges is defining what provider is responsible for managing treatment for different conditions, a complicated task because patients frequently are treated by a wide variety of providers and in numerous settings for many different problems.

For example, RAND researchers found that in more than half of the hip fractures they examined among Medicare beneficiaries, patients were treated in four or more different settings. For some conditions, including diabetes and low back pain, most patients were treated in just one setting.

In addition, many of the patients studied had multiple chronic conditions such as high blood pressure and elevated cholesterol levels. Encouraging a single-condition focus through an episode-based payment plan may not be optimal for these patients, according to the study.

RAND researchers outline several applied studies they say would facilitate more rapid movement of episode-based payment approaches from concept to implementation beyond the approaches used in the current pilot studies.

Among the issues studies must address are: how to define an episode of care; understanding the sources of variation within episodes of care; and whether some types of providers would be put at undue financial risk if their patients were treated under an episode of care scheme.

"Our analysis shows that doing these sorts of studies at the beginning of an evaluation period could help answer some important questions and increase the chance of success during real-world evaluations of episode-based payments." Hussey said. "Our recommendations serve as a starting point for a more-robust testing agenda."


'/>"/>

Contact: Warren Robak
robak@rand.org
310-451-6913
RAND Corporation
Source:Eurekalert

Related medicine news :

1. Study suggests obesity alone does not cause knee osteoarthritis in mice
2. Institute for Aging Research study links high-heels to heel and ankle pain
3. Heart Patients Benefit From At-Home Care, Study Finds
4. U-M study: Life and death during the Great Depression
5. UCLA study identifies 2 chemicals that could lead to new drugs for genetic disorders
6. New study resolves the mysterious origin of Merkel cells
7. Many Kids Suffer Medication Side Effects: Study
8. Swiss study finds income affects prostate cancer patients survival
9. Study finds intervention program increases kids healthy eating, reduces screen time
10. Exercise May Prevent Prostate Cancer: Study
11. Video: Despite Increased Health Threat, New Study Finds Low Concern About Flu Among Hispanics
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/8/2016)... ... 2016 , ... Stephanie Hebert Insurance Agency, serving families of ... charity campaign. As part of their ongoing community involvement program, funds are now ... children deserve a voice, and in the spirit of neighbors helping neighbors in ...
(Date:2/8/2016)... ... 2016 , ... Brenton Engineering , powered by Pro ... wrapped products at WestPack 2015, February 9-11, in Anaheim, California. This new solution ... or fully-automatic case packing with a small footprint, rugged, highly flexible, and cost-effective ...
(Date:2/8/2016)... Hilton Head Island, SC (PRWEB) , ... February 08, 2016 , ... ... Head and surrounding areas with a vital new community enrichment program, has teamed up ... to local women and children suffering from intimate abuse. To support all those victimized ...
(Date:2/8/2016)... ... , ... Delta Dental of California and its affiliated companies announced today that ... who recently retired as president and CEO of Delta Dental of California and its ... Year , helped lead the effort to raise funds for studies to strengthen pancreatic ...
(Date:2/8/2016)... ... February 08, 2016 , ... Eating disorders ... significant number of women and men with eating disorders report a history of ... predicts the development of an eating disorder. , At the 2016 iaedp ...
Breaking Medicine News(10 mins):
(Date:2/8/2016)... 8, 2016 /PRNewswire/--  Cell Applications, Inc. and ... services are now available in North ... (3D) bioprinting approach called the "Kenzan Method." Utilizing ... a state-of-the-art robotic system that fabricates 3D tissue ... pay-for-service bio-printing model that makes scaffold-free tissue available ...
(Date:2/8/2016)... Feb. 8, 2016 ... of the "Label-Free Detection Market by ... 2020" report to their offering. ... addition of the "Label-Free Detection Market ... to 2020" report to their offering. ...
(Date:2/8/2016)... , Feb. 8, 2016  Astellas Pharma Inc. President and ... promotion of James Robinson as president, Americas Operations, ... in North and South America , effective ... US, representing the commercial organization in the United ... Masao Yoshida , who is retiring in ...
Breaking Medicine Technology: