Carter Clement R, Bhat Suneel B, Clement Meredith E, Krieg James C
Rothman Institute at Thomas Jefferson University, 925 Chestnut St. Fifth Floor, Philadelphia, PA, 19107, USA.
Curr Rev Musculoskelet Med. 2017 Jun;10(2):224-232. doi: 10.1007/s12178-017-9406-7.
This paper reviews the history and structure of Medicare reimbursement with a focus on aspects relevant to the field of orthopedic surgery. Namely, this includes Parts A and B, with particular attention paid to the origins of Diagnosis Related Groups (DRG) and the physician fee schedule, respectively. We then review newer policies affecting orthopedic surgeons.
Recent Medicare reforms relevant to our field include readmission penalties, the evolution of bundled payments including the mandatory Comprehensive Care for Joint Replacement (CJR) and Surgical Hip and Femur Fracture Treatment (SHFFT) programs, and the new mandatory Merit-based Incentive Payment System (MIPS) pay-for-performance program. Providers are facing an increasingly complex payment system and are required to assume growing levels of financial risk. Physicians and practices who prepare for these changes will likely fare best and may even benefit.
综述目的：本文回顾了医疗保险报销的历史和结构，重点关注与骨科手术领域相关的方面。具体而言，这包括A部分和B部分，分别特别关注诊断相关分组（DRG）的起源和医师费用表。然后我们回顾了影响骨科外科医生的新政策。
最新发现：与我们领域相关的近期医疗保险改革包括再入院处罚、捆绑支付的演变，包括强制性的全关节置换综合护理（CJR）和髋部及股骨骨折手术治疗（SHFFT）计划，以及新的强制性基于绩效的激励支付系统（MIPS）绩效付费计划。医疗服务提供者正面临日益复杂的支付系统，并被要求承担越来越高的财务风险。为这些变化做好准备的医生和医疗机构可能表现最佳，甚至可能从中受益。
