Health Care Economics
Health Care Economics has become Health Care Reform, and reforming the American Delivery of Care has become a cultural and political movement. Historical presentation of the evolution of the current “Fee-For-Service” reimbursement methodology that is base
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Abbreviations ACA ACO ACS AMA APM BBA BPCI CEA CER CF CMMI CMS COBRA COBRA CPR CPT DSH FFS FFV GCP GDP GHS HCFA HHS HMO MGPO MVPS NHI NHR NQS
Patient Protection and Affordable Care Act 2010 Accountable Care Organizations American College of Surgeons American Medical Association Alternate payment models Budget Balanced Act 1997 Bundled Payment for Care Improvement Council of Economic Advisers Comparative effectiveness research Conversion factor Center for Medicare and Medicaid Innovation Center for Medicare and Medicaid The Consolidated Omnibus Budget Reconciliation Act 1985 The Consolidated Omnibus Budget Reconciliation Act 1986 Customary, prevailing, reasonable charges Current Procedural Terminology Disproportionate Share Hospitals/Safety Net Hospitals Fee-for-service Fee-For-Value Model Geisinger compensation plan Gross domestic product Geisinger Health System of Pennsylvania The Health Care Financing Administration The Department of Health and Human Services Health Maintenance Organization Massachusetts General Physicians Organization Medicare volume performance standards National health insurance National healthcare reform National strategy for quality improvement in health care
OBRA Part A Part B PCHI PEAC PERVUs PFS PLI PPRC RBRVS RUC RVS SGR SSTA TPC UAF UCR VBM wRVU
The Omnibus Budget Reconciliation Act 1989 Medicare Part A hospital payment Medicare Part B physician payment Partners Community Healthcare Inc. Practice Expense Advisory Committee Practice expense relative value units Medicare physician fee schedule Practice liability insurance Physician Payment Review Commission Resourced-based relative value scale American Medical Association Speciality Society Relative Value Scale Update Committee Relative value scale Sustainable Growth Rate Social Security Tax Act of 1935 Total physician compensation Updated adjustment factor Usual customary, reasonable charges Value-based modifier Work-relative value unit
Key Concepts • In 1965 President Lyndon B. Johnson signed Medicare and Medicaid Amendments (Titles XVIII and XIX) in to law. • In 1987 the Resource-Based Relative Value Scale was instituted as the basis for Medicare Physician-FeeSchedule. • All congressional attempts at controlling the rising cost of health care in America failed. • The Patient Protection and Affordable Care Act of 2010 mandated Alternative Payment Models. • These alternative payment models require clinical integration to be successful in decreasing costs, increasing efficiency and quality in the delivery of health care to patients.
© Springer International Publishing 2016 S.R. Steele et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, DOI 10.1007/978-3-319-25970-3_66
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• Surgeons will have to understand these new alternative payment models in order to continue to deliver quality cost-effective care to their patients. • The Resource-Based Relative Value Scale in combination with Quality Metrics will be the foundation of total compensation for surgeons within these new alternative payment models.
Introduction Hea
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