Kolarczyk Lavinia M, Arora Harendra, Manning Michael W, Zvara David A, Isaak Robert S
Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC.
Department of Anesthesiology, Duke University School of Medicine, Durham, NC.
J Cardiothorac Vasc Anesth. 2018 Feb;32(1):512-521. doi: 10.1053/j.jvca.2017.09.043. Epub 2017 Sep 28.
Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care.
医疗保健报销模式正在从基于数量的模式向基于价值的模式转变。基于价值的模式关注患者在住院期间和出院后的结果。这些模式强调成本、护理质量和多学科服务的协调。围手术期医生面临着评估传统做法的挑战，以确保提供协调、具有成本效益且基于证据的护理。随着医疗保险和医疗补助服务中心计划对冠状动脉搭桥手术引入捆绑支付，心血管麻醉医生要对出院后的结果承担财务责任。为了实现这些患者结果，必须设计、实施并维持多学科护理路径，而这一过程即便在最好的情况下也颇具挑战性。本综述：（1）提供医疗保健报销的历史视角；（2）将价值定义为与质量、服务和成本相关的内容；（3）回顾心脏手术基于价值的护理历史；（4）描述为血管手术患者进行优化的动力；（5）讨论诸如术后加速康复等项目如何协助提供基于价值的护理。
