Cheng Ryan, Wang Calvin, Sain Jared, Frias Giulia C, Melendez Justin X, Badalyan Nicole V, Carayannopoulos Nicolas L, Katt Brian M
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Hand (N Y). 2024 Dec 26:15589447241308606. doi: 10.1177/15589447241308606.
The purpose of this review is to examine the literature regarding episode-based bundled payment models for hand surgery. Health care and productivity costs associated with the surgical management of hand and wrist pathologies represent a substantial burden on the United States health care system. Traditional fee-for-service models fail to incentivize interdisciplinary collaboration and optimization of resources. More recently, the concept of episode-based bundled payments has evolved as a potential solution to rising health care costs by encouraging care coordination, streamlining billing processes, and linking reimbursement to quality metrics and patient outcomes as opposed to the volume of services rendered. Although episode-based bundled payments have demonstrated the potential to reduce health care costs in various medical specialties, their feasibility in hand surgery remains relatively unexplored. The transition to episode-based bundled payments in hand surgery hinges on the ability to incentivize physicians to work cohesively with other members of the care team to reduce low-value preoperative testing, optimize patients preoperatively, and establish treatment guidelines, especially for patients undergoing high-volume, low-complexity procedures. By fostering collaboration among stakeholders, leveraging data-driven insights, and prioritizing patient-centered care, episode-based bundled payments have the potential to enhance the value and efficiency of hand surgery services while improving patient outcomes. The current literature regarding episode-based bundled payments in hand surgery highlights various avenues for cost savings, including alternative sites of service, surgical approaches, use of anesthesia, and the elimination of low-value tests, and demonstrates that there is sufficient evidence to proceed to a trial phase for episode-based bundled payments in hand surgery.
本综述的目的是研究关于手部手术基于病例的捆绑支付模式的文献。与手部和腕部疾病手术治疗相关的医疗保健和生产力成本给美国医疗保健系统带来了沉重负担。传统的按服务收费模式无法激励跨学科协作和资源优化。最近,基于病例的捆绑支付概念逐渐发展起来,作为应对不断上涨的医疗保健成本的一种潜在解决方案,它鼓励医疗协调、简化计费流程,并将报销与质量指标和患者结果挂钩,而不是与所提供服务的数量挂钩。尽管基于病例的捆绑支付已显示出在各种医学专科中降低医疗保健成本的潜力,但其在手部手术中的可行性仍相对未被探索。手部手术向基于病例的捆绑支付的转变取决于能否激励医生与护理团队的其他成员紧密合作,以减少低价值的术前检查、在术前优化患者状况并制定治疗指南,特别是对于接受大量低复杂性手术的患者。通过促进利益相关者之间的合作、利用数据驱动的见解并将以患者为中心的护理放在首位,基于病例的捆绑支付有可能提高手部手术服务的价值和效率,同时改善患者结果。当前关于手部手术基于病例的捆绑支付的文献强调了各种节省成本的途径,包括替代服务地点、手术方法、麻醉的使用以及消除低价值检查,并表明有足够的证据进入手部手术基于病例的捆绑支付的试验阶段。