Seidenwurm David, Lexa Frank James
Sutter Health, Sacramento, California.
The Wharton School, University of Pennsylvania.
J Am Coll Radiol. 2016 Sep;13(9):1029-31. doi: 10.1016/j.jacr.2016.01.024. Epub 2016 May 18.
Bundled or episode payments are among the most heavily emphasized approaches to aligning incentives and promoting care coordination, efficiency, and accountability in health care redesign. Bundled or episode payments price a market basket of services for an entire episode of care with both a clearly defined trigger and termination. Because the radiologist is "ancillary" in many bundles, the specialty is often unaware of the phenomenon. This is likely to change rapidly. Radiology is pivotal in high-prevalence, high-impact care areas such as low back pain and stroke that are focuses of widely used system performance metrics. More important, radiology is central to the diagnosis and management of a wide range of important diagnostic issues in areas such as breast cancer, pulmonary nodules, and incidental findings. Three models of bundled care will probably involve radiology intimately in the near future. Pure radiology bundles might be constructed for breast cancer screening and diagnosis, and these could be priced on the basis of guideline-based best-practice frequencies of care events such as recall and biopsy. Clinical bundles, for example low back pain, could be priced on the basis of optimal imaging frequencies. Finally, pricing of imaging studies might include evidence-based frequencies of follow-up imaging for incidental findings.
捆绑支付或按诊疗流程付费是医疗保健重新设计中为调整激励措施、促进医疗协调、提高效率和增强问责制而最为强调的方法之一。捆绑支付或按诊疗流程付费为整个诊疗过程的一篮子服务定价，同时明确规定了触发条件和终止条件。由于放射科医生在许多捆绑支付模式中属于“辅助人员”，该专业往往未意识到这一现象。这种情况可能很快就会改变。放射学在诸如腰痛和中风等高发性、高影响性的医疗领域中起着关键作用，而这些领域是广泛使用的系统性能指标的重点关注对象。更重要的是，放射学对于乳腺癌、肺结节和偶然发现等领域中广泛的重要诊断问题的诊断和管理至关重要。在不久的将来，三种捆绑式医疗模式可能都会密切涉及放射学。可能会构建针对乳腺癌筛查和诊断的纯放射学捆绑支付模式，这些模式可以根据诸如召回和活检等基于指南的最佳实践诊疗事件频率来定价。临床捆绑支付模式，例如腰痛，可根据最佳成像频率定价。最后，影像检查的定价可能包括针对偶然发现进行循证随访成像的频率。
