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Bishay AE, Lyons AT, Koester SW, Paulo DL, Liles C, Dambrino RJ, Feldman MJ, Ball TJ, Bick SK, Englot DJ, Chambless LB. Global Economic Evaluation of the Reported Costs of Deep Brain Stimulation. Stereotact Funct Neurosurg 2024:1-17. [PMID: 38513625 DOI: 10.1159/000537865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Despite the known benefits of deep brain stimulation (DBS), the cost of the procedure can limit access and can vary widely. Our aim was to conduct a systematic review of the reported costs associated with DBS, as well as the variability in reporting cost-associated factors to ultimately increase patient access to this therapy. METHODS A systematic review of the literature for cost of DBS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Embase databases were queried. Olsen & Associates (OANDA) was used to convert all reported rates to USD. Cost was corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022. RESULTS Twenty-six articles on the cost of DBS surgery from 2001 to 2021 were included. The median number of patients across studies was 193, the mean reported age was 60.5 ± 5.6 years, and median female prevalence was 38.9%. The inflation- and currency-adjusted mean cost of the DBS device was USD 21,496.07 ± USD 8,944.16, the cost of surgery alone was USD 14,685.22 ± USD 8,479.66, the total cost of surgery was USD 40,942.85 ± USD 17,987.43, and the total cost of treatment until 1 year of follow-up was USD 47,632.27 ± USD 23,067.08. There were no differences in costs observed across surgical indication or country. CONCLUSION Our report describes the large variation in DBS costs and the manner of reporting costs. The current lack of standardization impedes productive discourse as comparisons are hindered by both geographic and chronological variations. Emphasis should be put on standardized reporting and analysis of reimbursement costs to better assess the variability of DBS-associated costs in order to make this procedure more cost-effective and address areas for improvement to increase patient access to DBS.
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Affiliation(s)
- Anthony E Bishay
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Stefan W Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Danika L Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Feldman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tyler J Ball
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah K Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Schloemann DT, Ricciardi BF, Thirukumaran CP. Disparities in the Epidemiology and Management of Fragility Hip Fractures. Curr Osteoporos Rep 2023; 21:567-577. [PMID: 37358663 DOI: 10.1007/s11914-023-00806-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to synthesize the recently published scientific evidence on disparities in epidemiology and management of fragility hip fractures. RECENT FINDINGS There have been a number of investigations focusing on the presence of disparities in the epidemiology and management of fragility hip fractures. Race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities have been the primary focus of these investigations. Comparatively fewer studies have focused on why these disparities may exist and interventions to reduce disparities. There are widespread and profound disparities in the epidemiology and management of fragility hip fractures. More studies are needed to understand why these disparities exist and how they can be addressed.
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Affiliation(s)
- Derek T Schloemann
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Benjamin F Ricciardi
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Caroline P Thirukumaran
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Ndayishimiye C, Tambor M, Dubas-Jakóbczyk K. Barriers and Facilitators to Health-Care Provider Payment Reform - A Scoping Literature Review. Risk Manag Healthc Policy 2023; 16:1755-1779. [PMID: 37701321 PMCID: PMC10494919 DOI: 10.2147/rmhp.s420529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023] Open
Abstract
Background Changes to provider payment systems are among the most common reforms in health care. They are important levers for policymakers to influence the health system performance. The aim of this study was to identify, systematize, and map the existing literature on the factors that influence health-care provider payment reforms. Methods A scoping review was conducted. Literature published in English between 2000 and 2022 was systematically searched in five databases, relevant organizations, and journals. Academic publications and grey literature on health-care provider payment reform and the factors influencing reform were considered. An inductive thematic analysis was applied to map the barriers and facilitators that influence payment reforms. Results The study included 51 publications. They were divided into four categories: empirical studies (n=17), literature reviews (n=6), discussion/policy papers (n=18), and technical reports/policy briefs (n=9). Most of the studies were conducted in developed economy countries (n=36). The most frequently reformed payment method was fee-for-service (n=37), and the newly implemented methods included bundled payments (n=16), pay-for-performance (n=15), and diagnosis-related groups (n=11). This study identified 43 sub-themes on barriers to provider payment reforms, which were grouped into eight main themes. It identified 51 sub-themes on facilitators, which were grouped into six themes. Barriers include stakeholder opposition, challenges related to reform design, hurdles in implementation structures, insufficient resources, challenges related to market structures, legal barriers, knowledge and information gaps, and negative publicity. Facilitators include stakeholder involvement, complementary reforms/policies, relevant prior experience, good leadership and management of change, sufficient resources, and external pressure to introduce reform. Conclusion The factors that influence health-care payment reforms are often contextual and interrelated, and encompass a variety of perspectives, including those of patients, providers, insurers, and policymakers. When planning reforms, one should anticipate potential barriers and devise appropriate interventions. Registration The study was registered with the Open Science Framework.
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Affiliation(s)
- Costase Ndayishimiye
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Marzena Tambor
- Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
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Dehanne F, Gourdin M, Devleesschauwer B, Bihin B, Van Wilder P, Mareschal B, Leclercq P, Pirson M. Cost-DALY comparison of hip replacement care in 12 Belgian hospitals. BMJ Open Qual 2021; 10:bmjoq-2020-001263. [PMID: 34580082 PMCID: PMC8477339 DOI: 10.1136/bmjoq-2020-001263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/13/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In view of the expected increase in expenditure on hip replacement treatment in Belgium, the complication rate and potential waste reduction, as estimated by the Organisation for Economic Cooperation and Development, we are not yet in a position to assess the efficiency of hip replacement treatment in Belgian hospitals. This objective study uses a cost-disability-adjusted life years (DALYs) ratio to propose a comparison of hip replacement surgery among 12 Belgian hospitals. METHODS Our study seeks to innovate by proposing an interhospital comparison that simultaneously integrates the weighting of quality indicators and the costs of managing a patient. To this end, we associated a DALY impact with each patient safety indicator, readmission and mortality outcome. We then compared hospitals using both costs and DALYs adjusted to their case mix index. The adjusted values (costs and DALYs) were obtained by relating the observed value to the predicted value obtained from the linear regression model. RESULTS We registered a total of 246.5 DALYs for the 12 hospital institutions, the average cost (SD) of a stay being €8013 (€4304). Our model allowed us to identify hospitals with observed values higher than those predicted. Out of the 12 hospitals evaluated, 4 need to reduce costs and DALYs impacts, 6 have to improve one of the two factors and 2 appear to have good results. The costs for the worst performing hospitals can rise to over €150 000. CONCLUSION Evaluating the rates of patient safety indicators, associated with cost, is a prerequisite for quality and cost improvement efforts on the part of managers and practitioners. However, it appears essential to evaluate the entire care chain using a comparable unit of measurement. The hospital's case mix index must also be considered in benchmarking to avoid drawing the wrong conclusions. In addition, other indicators, such as the patient's perception of the actual results, should be added to our study.
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Affiliation(s)
- Fabian Dehanne
- General Management, CHU UCL Namur, Yvoir, Belgium .,ESP, ULB, Bruxelles, Belgium
| | | | | | - Benoit Bihin
- General Management, CHU UCL Namur, Yvoir, Belgium
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Higher complication rates after management of lower extremity fractures in lower socioeconomic classes: Are risk adjustment models necessary? TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620975693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
IntroductionAlternative payment models, such as bundled payments, have been proposed to control rising costs in orthopaedic trauma surgery. Without risk adjustment models, concerns exist about the financial burden incurred by so called “safety-net hospitals” that serve patients of lower socioeconomic status. The purpose of this study was to determine whether lower socioeconomic status was associated with increased complications and subsequently higher resource utilization following surgical treatment of high-energy lower extremity fractures.MethodsThe National Inpatient Sample database was queried for patients who underwent surgical fixation of the femur and tibia between 2005–2014. The top and bottom income quartiles were compared. Demographics, medical comorbidities, length of stay (LOS), complications, in-hospital mortality were compared between patients of top and bottom income quartiles. Multivariate logistic regression analysis was then performed to identify factors independently associated with complications, mortality, and increased resource utilization.ResultsPatients with femur fracture in the bottom income quartile had longer length of stay (6.9 days vs 6.5 days, p < 0.001) and a higher mortality rate (1.9% vs 1.7%, p = 0.034). Patients with tibia fracture in the bottom income quartile had greater complication rates (7.3% vs 6.1%, p < 0.001), longer length of stay (5.3 days vs. 4.5 days, p < 0.001), and higher mortality (0.3% vs. 0.2%, p < 0.001).ConclusionsLower income status is associated with increased in-hospital mortality and longer length of stay in patients following lower extremity fractures. Risk adjustment models should consider the role of socioeconomic status in patient resource utilization to ensure continued access to orthopedic trauma care for all patients.
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AlRuthia Y, Abdulaziz Bin Aydan N, Sulaiman Alorf N, Asiri Y. How can Saudi Arabia reform its public hospital payment models? A narrative review. Saudi Pharm J 2020; 28:1520-1525. [PMID: 33041625 PMCID: PMC7537664 DOI: 10.1016/j.jsps.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The cost of Saudi healthcare continues to rise at an alarming rate, putting the sustainability of the public healthcare system into question. Data have shown that hospital and healthcare providers' services represent the bulk of this rising cost, which makes the calls to reform the Saudi healthcare system more focused on payment models than at any time before. OBJECTIVE The aim of this paper is to review various identified payment models that can be used to contain costs and improve the quality of the care provided. METHOD A literature review of articles addressing the issues of cost containment and improving the quality of healthcare by reforming the current Saudi healthcare payment policy were identified through the Ovid®, Medline, and Google® Scholar search engines. RESULTS AND CONCLUSIONS Many research articles and literature reviews have identified and discussed different models of healthcare payments. Some articles have focused on one payment model, while others have discussed different payment models that have been identified. There is an urgent need to reform the current system of healthcare payments to improve the quality of healthcare and maintain funding for universal healthcare coverage in the future. Future healthcare payment reforms should consider restructuring the current healthcare system, which is largely fragmented by providing incentives to different governmental healthcare sectors, in order to transform it into a more organized and coordinated system. Thus far, there is not a single payment model that can, by itself, reduce healthcare costs and improve healthcare quality. Future healthcare reforms should use a mixture of different payment models to pay hospitals and physicians.
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Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Nora Sulaiman Alorf
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Malik AT, Quatman CE, Phieffer LS, Ly TV, Khan SN. Timing of complications following surgery for geriatric hip fractures. J Clin Orthop Trauma 2019; 10:904-911. [PMID: 31528066 PMCID: PMC6739463 DOI: 10.1016/j.jcot.2018.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/27/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Despite abundant literature present on complications following hip fracture surgery, few studies have focused on the timing of these complications. MATERIALS AND METHODS The 2015-2016 American College of Surgeons - National Surgical Quality Improvement Program database was queried for patients ≥65 years of age undergoing hip fracture surgery, due to trauma, using CPT-Codes for total hip arthroplasty (27130), Hemiarthroplasty (27125) and Open Reduction/Internal Fixation (ORIF) (27236, 27244, 27245). For each complication being studied, the median time to diagnosis was determined along with the interquartile range (IQR). Cox-regression analyses were used to assess complication timings between various surgeries. RESULTS A total of 31,738 were included in the final cohort. The median time of occurrence (days) for myocardial infarction was 2 [IQR 1-6], pneumonia 4 [IQR 2-12], stroke/CVA 3 [IQR 1-10], pulmonary embolism 5 [IQR 2-14], urinary tract infection (UTI) 8 [IQR 2-15], deep venous thrombosis (DVT) 9 [IQR 4-17], sepsis 11 [IQR 5-19], death 12 [IQR 6-20], superficial surgical site infection (SSI) 16 [IQR 12-22], deep SSI 23 [IQR 15-24] and organ/space SSI 19 [IQR 15-23]. Undergoing a THA vs. ORIF for hip fracture was associated a relatively early occurrence of pneumonia (day 3 [IQR 1-5.25]; p = 0.029) and urinary tract infection (day 4 [IQR 1-13]; p = 0.035) and a later occurrence of organ/space SSI (day 23.5 [IQR 19.5-26.75]; p = 0.002). CONCLUSION Orthopaedic trauma surgeons can utilize this data to optimize care strategies during the time-periods of highest risk to prevent complications from occurring early on in the course of post-operative care.
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Affiliation(s)
| | | | | | | | - Safdar N. Khan
- Corresponding author. Division of Spine Surgery, Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. https://spine.osu.edu/about/our-team
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Martin BI, Lurie JD, Farrokhi FR, McGuire KJ, Mirza SK. Early Effects of Medicare's Bundled Payment for Care Improvement Program for Lumbar Fusion. Spine (Phila Pa 1976) 2018; 43:705-711. [PMID: 28885288 PMCID: PMC5839918 DOI: 10.1097/brs.0000000000002404] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of Medicare claims linked to hospital participation in the Center for Medicare and Medicaid Innovation's episode-based Bundled Payment for Care Improvement (BPCI) program for lumbar fusion. OBJECTIVE To describe the early effects of BPCI participation for lumbar fusion on 90-day reimbursement, procedure volume, reoperation, and readmission. SUMMARY OF BACKGROUND DATA Initiated on January 1, 2013, BPCI's voluntary bundle payment program provides a predetermined payment for services related to a Diagnosis-Related Group-defined "triggering event" over a defined time period. As an alternative to fee-for-service, these reforms shift the financial risk of care on to hospitals. METHODS We identified fee-for-service beneficiaries over age 65 undergoing a lumbar fusion in 2012 or 2013, corresponding to the years before and after BPCI initiation. Hospitals were grouped based on program participation status as nonparticipants, preparatory, or risk-bearing. Generalized estimating equation models adjusting for patient age, sex, race, comorbidity, and hospital size were used to compare changes in episode costs, procedure volume, and safety indicators based on hospital BPCI participation. RESULTS We included 89,605 beneficiaries undergoing lumbar fusion, including 36% seen by a preparatory hospital and 7% from a risk-bearing hospital. The mean age of the cohort was 73.4 years, with 59% women, 92% White, and 22% with a Charlson Comorbidity Index of 2 or more. Participant hospitals had greater procedure volume, bed size, and total discharges. Relative to nonparticipants, risk-bearing hospitals had a slightly increased fusion procedure volume from 2012 to 2013 (3.4% increase vs. 1.6% decrease, P = 0.119), did not reduce 90-day episode of care costs (0.4% decrease vs. 2.9% decrease, P = 0.044), increased 90-day readmission rate (+2.7% vs. -10.7%, P = 0.043), and increased repeat surgery rates (+30.6% vs. +7.1% points, P = 0.043). CONCLUSION These early, unintended trends suggest an imperative for continued monitoring of BPCI in lumbar fusion. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Brook I Martin
- Department of Orthopedics, University of Utah, Salt Lake City, UT
| | - Jon D Lurie
- Department of Orthopedics, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | | | - Kevin J McGuire
- Department of Orthopedic Surgery, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Sohail K Mirza
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
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Iorio R, Bosco J, Slover J, Sayeed Y, Zuckerman JD. Single Institution Early Experience with the Bundled Payments for Care Improvement Initiative. J Bone Joint Surg Am 2017; 99:e2. [PMID: 28060238 DOI: 10.2106/jbjs.16.00066] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Centers for Medicare & Medicaid Services (CMS) implemented the Bundled Payments for Care Improvement (BPCI) initiative in 2011. Through BPCI, organizations enlisted into payment agreements that include both performance and financial accountability for episodes of care. To succeed, BPCI requires quality maintenance and care delivery at lower costs. This necessitates physicians and hospitals to merge interests. Orthopaedic surgeons must assume leadership roles in cost containment, surgical safety, and quality assurance to deliver cost-effective care. Because most orthopaedic surgeons practice independently and are not employed by hospitals, models of physician-hospital alignment (e.g., physician-hospital organizations) or contracted gainsharing arrangements between practices and hospitals may be necessary for successful bundled pricing. Under BPCI, hospitals, surgeons, or third parties share rewards but assume risks for the bundle.For patients, cost savings must be associated with maintenance or improvement in quality metrics. However, the definition of quality can vary, as can the rewards for processes and outcomes. Risk stratification for potential complications should be considered in bundled pricing agreements to prevent the exclusion of patients with substantial comorbidities and higher care costs (e.g., hip fractures treated with prostheses). Bundled pricing depends on economies of scale for success; smaller institutions must be cautious, as 1 costly patient could substantially impact the finances of its entire program. CMS recommends a minimum of 100 to 200 cases yearly. We also suggest that participants utilize technologies to maximize efficiency and provide the best possible environment for implementation of bundled payments. Substantial investment in infrastructure is required to develop programs to improve coordination of care, manage quality data, and distribute payments. Smaller institutions may have difficulty devoting resources to these infrastructural changes, although changes may be implemented more thoroughly once initiated. Herein, we discuss our early total joint arthroplasty BPCI experience at our tertiary-care academic medical center.
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Affiliation(s)
- Richard Iorio
- 1Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, NY
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Xu GC, Luo Y, Li Q, Wu MF, Zhou ZJ. Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China. Chin Med J (Engl) 2016; 129:953-9. [PMID: 27064041 PMCID: PMC4831531 DOI: 10.4103/0366-6999.179796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services. Methods: This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination. Results: We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups. Conclusions: We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.
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Affiliation(s)
| | | | | | | | - Zi-Jun Zhou
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
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Lake C. Response to: ‘Improving the care of patients with a hip fracture: a quality improvement report’ by Hawkes et al. BMJ Qual Saf 2016; 25:295. [DOI: 10.1136/bmjqs-2015-005077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/03/2022]
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Risk factors for adverse cardiac events in hip fracture patients: an analysis of NSQIP data. INTERNATIONAL ORTHOPAEDICS 2015. [DOI: 10.1007/s00264-015-2832-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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