Opportunities for Surgical Leadership in Managing Population Health Costs.
Opportunities for Surgical Leadership in Managing Population Health Costs.
复制标题
管理人口健康成本的外科领导机会。
DOI：
10.1097/sla.0000000000001759
复制
发表时间：
2016
影响因子：
9
通讯作者：
Dimick,JustinB
中科院分区：
文献类型：
--
作者：
Nathan,Hari;Dimick,JustinB
人口健康管理的概念长期以来一直是初级保健和慢性病管理的支柱，它正在外科手术中扎根。2010年《平价医疗法案》（ACA）引入了几种创新的支付模式，将人口成本的责任转移到卫生系统和提供者身上。美国人口卫生费用的这些变化将为外科医生积极参与人口卫生费用的管理创造一个任务和机会。这些支付实验标志着美国医疗保健融资的巨大变化。医疗保险和医疗补助服务中心（CMS）的目标是到2018年将50%的医疗保险支付与这种替代支付模式挂钩。1迄今为止，CMS主要将这些举措集中在慢性疾病上，但显然即将更加注重外科护理。例如，全髋关节和膝关节置换术现在被纳入减少再入院计划，冠状动脉旁路移植术很快就会跟进。关节置换综合护理（CCJR）计划将在75个地区的医院强制进行关节置换捆绑支付。鉴于住院手术占美国所有医院和医生支出的40%，2未来的支付实验将不可避免地包括更多的外科手术。对传统的按服务收费医疗最具颠覆性的支付创新是责任医疗组织（ACO）。ACO是由医生、医院和其他医疗保健提供者组成的团体，他们被组织起来并受到激励，以提高患者护理的质量、效率和价值。ACO的共同点是，提供者分享医疗成本节约的回报，在某些情况下，还分享成本超支的风险。ACO代表了外科医生立即影响基于人群的手术成本管理的理想工具。它们是人口健康管理的最突出和最受欢迎的模式，因此可作为节省成本实验的实验室。CMS和私人付款人都支持建立ACO，超过2300万美国人现在由740多个公共和私人ACO覆盖。[3]最大的单一此类计划是医疗保险共享储蓄计划（SSP），其中包括404个SSP ACO中的近800万患者。4这一规模将允许在人群水平上进行手术成本管理的创新，并产生广泛的直接影响。
The concept of population health management—long a mainstay in primary care and chronic disease management—is taking root in surgery. The 2010 Affordable Care Act (ACA) ushered in the implementation of several innovative payment models that shift accountability for population costs to health systems and providers. These changes in American population health costs care financing will create both a mandate and an opportunity for surgeons to actively participate the management of population health costs. These payment experiments signal a sea change in healthcare financing in the United States. The Centers for Medicare and Medicaid Services (CMS) aims to have 50% of all Medicare payments tied to such alternative payment models by 2018. 1 To date, CMS has primarily focused these initiatives on chronic medical conditions, but a stronger focus on surgical care is clearly on the horizon. For example, total hip and knee arthroplasty are now included in the Hospital Readmissions Reduction Program, with coronary artery bypass grafting soon to follow. The Comprehensive Care for Joint Replacement (CCJR) program will make bundled payment for joint replacements mandatory for hospitals in 75 regions. Given that inpatient surgery accounts for 40% of all hospital and physician spending in the United States, 2 it is inevitable that more surgical procedures will be included in future payment experiments.The payment innovation that is most disruptive to traditional fee-for-service medicine is the Accountable Care Organization (ACO). ACOs are groups of physicians, hospitals, and other healthcare providers that are organized and incentivized to improve the quality, efficiency, and value of care for their patients. The common thread in ACOs is that providers share the rewards of healthcare cost savings, and in some cases the risks of cost overruns. ACOs represent an ideal vehicle for surgeons to immediately impact populationbased management of surgical costs. They are the most prominent and popular model of population health management and therefore serve as a laboratory for cost-saving experiments. Both the CMS and private payers are supporting the establishment of ACOs, and over 23 million Americans are now covered by more than 740 public and private ACOs. 3 The largest single such program is the Medicare Shared Savings Program (SSP), which includes almost 8 million patients in 404 SSP ACOs. 4 This scale will allow innovations in surgical cost management to be conducted on a population level and have broad immediate impact.