Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY.
J Bone Joint Surg Am. 2018 Nov 21;100(22):e144. doi: 10.2106/JBJS.18.00571.
The original architects of Medicare modeled the payment system on the existing fee-for-service (FFS) structure that historically dominated the health-insurance market. Under the FFS paradigm, health-care expenditures experienced an exponential rise. In response, the managed care and capitation models of health-care delivery were developed. However, changes in Medicare reimbursement, along with an increasing volume of orthopaedic procedures and escalating implant costs, call into question the cost-effectiveness of this service line. The success of the Medicare Acute Care Episode (ACE) Demonstration Project proved the feasibility of value-based care and ushered in a new era of bundled payment initiatives.
医疗保险的最初设计者以历史上主导医疗保险市场的现行按服务项目付费（FFS）结构为蓝本设计了支付体系。在 FFS 模式下，医疗保健支出呈指数级增长。为应对这一情况，发展了管理式医疗和人头付费的医疗服务提供模式。然而，医疗保险报销的变化，以及不断增加的骨科手术量和不断攀升的植入物成本，使得这条服务线的成本效益受到质疑。医疗保险急性病治疗案例（ACE）示范项目的成功证明了基于价值的医疗保健的可行性，并开创了捆绑式支付举措的新时代。
