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Development of alternative payment models for surgical care
Alternative Payment Models (APMs) have been of growing importance in the Medicare Program for several years. Recently passed laws have created additional incentives for the creation of, and participation in APMs that meet certain requirements related to quality, risk, and use of certified EHR technology. The American College of Surgeons has undertaken an effort to develop an APM that recognizes the importance of team-based, patient-centered care and surgeon leadership in improving outcomes and patient experience while allowing surgeons to share in savings from reductions in cost. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Frank G. Opelka, Jill S. Sage, Matthew R. Coffron Source Type: research

The hospital-acquired condition reduction program for colorectal surgery: current initiatives and implications for the future
The 2010 Patient Protection and Affordable Care Act (PPACA) 1 sought to reform healthcare in the United States through a myriad of initiatives that included expanding health insurance accessibility, mandating coverage, revising and expanding a multitude of government programs, and incentivizing improved quality and value in healthcare delivery 2. One initiative aimed at containing costs and improving patient outcomes is the Hospital-Acquired Condition Reduction Program (HACRP). Like the Hospital Readmission Reduction Program (HRRP), the goal of this program is to stratify hospitals based on their outcomes, in this case a c...
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Richard S. Hoehn, Ian M. Paquette Source Type: research

Bundled Care Payment Models
In response to rising national healthcare spending, the Medicare program has proposed episode-based payments models as an alternative to the traditional fee-for-service program. A “bundled payment” is a single reimbursement provided for all aspects of care for a single diagnosis or procedure. This reimbursement model is argued to improve care delivery by accomplishing the following goals: 1. Improve coordination between hospital and physicians as well as between different care teams. 2. Improve efficiency of care thereby reducing spending. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Arielle E Kanters, Chad Ellimoottil Source Type: research

Assessing Quality in Payment Reform Initiatives
Rising healthcare costs and increasing evidence of variation in quality of health care have spurred payment reform initiatives that tie reimbursement to the quality of care provided. Success in these initiatives will require identification of valid and reliable measures of quality and rigorous evaluation of the effects of payment reform implementation on these quality metrics. Despite the support and investment in quality improvement through payment reform, results of these improvement initiatives have been mixed. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Anne-Lise D. D ′Angelo, Elise H. Lawson Source Type: research

Private Payer Value Initiatives: The Michigan Model
The recent national emphasis on improving value in healthcare delivery has placed increasing responsibility for health care value improvement on individual hospitals through financial incentives. Private Payer Initiatives are partnerships between providers and hospitals with payers that are intended to improve quality and value of health care. Blue Cross Blue Shield of Michigan has been a pioneer in the development and financial support of “The Michigan Model.” The Michigan Model is a is a longstanding multifaceted initiative that has successfully improved quality of healthcare delivery throughout the state through the...
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Sarah Shubeck, Scott E. Regenbogen Source Type: research

The value of patient-reported outcomes in colon and rectal surgery
Quality in surgery is often assessed in terms of perioperative complications, such as surgical site infections and readmissions. Although patients are the ultimate end-users of surgical care, the impact of surgical care on aspects of health that are most important to them, such as functional status, is rarely assessed. Value is in the eye of the beholder. Patient-reported outcomes provide patients a voice in the assessment of their care quality, and brings greater accountability into the assessment of value. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Jason B. Liu, Julia R. Berian, Larissa K. Temple Source Type: research

Public reporting of surgical outcomes
As a result of pressures from patients, payers, and providers, mechanisms that measure and publicly report surgical outcomes have emerged rapidly over the last two decades. This growing movement is the result of an increasing demand for transparency and accountability. Processes that generate these outcomes reports, however, are challenged by issues related to accuracy and bias. Furthermore, the impact of reports on behaviors within the healthcare marketplace is complicated. In order to better understand the current state and future of public reporting within the United States, a brief review of the history of this movemen...
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: David A. Etzioni Source Type: research

Development of Alternative Payment Models for Surgical Care
Alternative Payment Models (APMs) have been of growing importance in the Medicare Program for several years. Recently passed laws have created additional incentives for the creation of, and participation in APMs that meet certain requirements related to quality, risk, and use of certified EHR technology. The American College of Surgeons has undertaken an effort to develop an APM that recognize the importance of team-based, patient centered care and surgeon leadership in improving outcomes and patient experience while allowing surgeons to share in savings from reductions in cost. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Frank Opelka, Jill Sage, Matthew Coffron Source Type: research

Introduction: Value-based reimbursement
The landscape of health care reimbursement reform has been changing fast. A practicing colon and rectal surgeon can be forgiven for feeling that the pace of change and the opportunities for confusion have surged. Many are aware of the federal Centers for Medicare and Medicaid Services ’ (CMS) declared intention to transition an increasing share of its reimbursement from volume-based to value-based reimbursement,1 but the ways in which this transition will take place remain unclear to most of us. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 1, 2018 Category: Gastroenterology Authors: Scott E. Regenbogen Source Type: research

Readmissions, penalties, and the Hospital Readmissions Reduction Program
Preventable readmissions represent a considerable economic burden on the healthcare system in the United States, and have emerged as targets in value-based initiatives in recent legislation. The Hospital Readmissions Reduction Program (HRRP) was established as part of the Affordable Care Act (ACA) to provide a financial incentive for hospitals to engage in quality improvement efforts to reduce readmissions, by levying penalties for Medicare reimbursements to hospitals with higher-than-expected rates of readmissions. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 1, 2018 Category: Gastroenterology Authors: Audrey S. Kulaylat, Jeah Jung, Christopher S. Hollenbeak, Evangelos Messaris Source Type: research

Introduction: Value-Based Reimbursement
The landscape of health care reimbursement reform has been changing fast. A practicing colon and rectal surgeon can be forgiven for feeling that the pace of change and the opportunities for confusion have surged. Many are aware of the federal Centers for Medicare and Medicaid Services ′ (CMS) declared intention to transition an increasing share of its reimbursement from volume-based to value-based reimbursement,1 but the ways in which this transition will take place remain unclear to most of us. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 1, 2018 Category: Gastroenterology Authors: Scott E. Regenbogen Source Type: research

Readmissions, penalties, and the hospital readmissions reduction program
Preventable readmissions represent a considerable economic burden on the healthcare system in the United States, and have emerged as targets in value-based initiatives in recent legislation. The Hospital Readmissions Reduction Program (HRRP) was established as part of the Affordable Care Act (ACA) to provide a financial incentive for hospitals to engage in quality improvement efforts to reduce readmissions, by levying penalties for Medicare reimbursements to hospitals with higher-than-expected rates of readmissions. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 1, 2018 Category: Gastroenterology Authors: Audrey S. Kulaylat, Jeah Jung, Christopher S. Hollenbeak, Evangelos Messaris Source Type: research

The Risk of Prescribing Antibiotics “just-in-case” There is Infection
The habit of prescribing antibiotics “just-in-case” there is infection is based on the misguided perception that antibiotics are “safe” drugs and therefore pose little risk to patients. Surgeons need to dispel this myth. One in five patients experience an antibiotic adverse drug event. The risk of overprescribing antibiotics fa r outweighs the perceived benefit and contributes to antibiotic resistance which not only threatens the efficacy of prophylaxis it also threatens the practice of surgery. Every unnecessary antibiotic contributes to a scenario in which patients who need surgery can no longer be protected from...
Source: Seminars in Colon and Rectal Surgery - September 22, 2017 Category: Gastroenterology Authors: Debra A. Goff, Thomas M. File Source Type: research

Influence of the intestinal microbiome on anastomotic healing in the colon and rectum
Colonic and rectal anastomotic leak has long plagued the surgeons, without much improvement despite decades of advances in suture technique and technology. At the intersection of microbiotal changes in flux via a combination of environmental factors and the virulent pathology of the organisms colonizing the gastrointestinal tract, lies an underappreciated mechanism and thus possible solution for anastomotic failure. Through pre-operative preparation, intra-operative manipulation, and post-operative management, the flora is constantly changing. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2017 Category: Gastroenterology Authors: Connie Shao, Sara Gaines, John C Alverdy Source Type: research

The evolution of bowel preparation for gastrointestinal surgery
Mechanical and antibiotic bowel preparation have swung in and out of favor among gastrointestinal surgeons. The evidence is reviewed for mechanical and antibiotic bowel preparation, respectively. However, the emerging microbiome science represents an opportunity to view bowel preparation differently. The role of the microbiome on the gastrointestinal tract in both health and disease is briefly reviewed. A better understanding of the complexity of the microbiome may provide the impetus to improve and evolve current bowel preparation practices. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2017 Category: Gastroenterology Authors: Julia R. Berian, Neil Hyman Source Type: research