Featured Research

from universities, journals, and other organizations

Bundled payments come to gastroenterology

Date:
March 24, 2014
Source:
American Gastroenterological Association
Summary:
Patients want physicians to provide high-quality care and the health system requires good value for physician work. To help gastroenterologists achieve these goals, the American Gastroenterological Association (AGA) has developed a colonoscopy bundled payment model.

Patients want physicians to provide high-quality care and the health system requires good value for physician work. To help gastroenterologists achieve these goals, the American Gastroenterological Association (AGA) has developed a colonoscopy bundled payment model, which has been published in Gastroenterology, the official journal of the AGA.

By developing a framework and educating gastroenterologists about value-based reimbursement, the AGA hopes to inform physicians who wish to consider contracting with payors, purchasers and risk-bearing organizations around new payment models.

"Developing and negotiating bundled payments is one option in the transition to value-based care," according to John I. Allen, MD, MBA, AGAF, AGA Institute president elect, and an author of the colonoscopy bundle. "Practices that perform procedures in high-quality, cost-efficient settings will be rewarded and can use a bundled payment mechanism for negotiation and alignment with health-care systems."

The framework for the AGA bundled payment model is specifically for colonoscopy for colorectal cancer (CRC) screening, diagnosis and surveillance. The colonoscopy bundle model includes services and supplies provided in the pre-procedure period, the day of the colonoscopy, and the post-procedure period. The bundle provides a framework for physicians and facilities to consider scenarios when negotiating payment, such as poor preparation, incomplete procedures, and post-polypectomy bleeding. In creating the framework, the AGA had expert input from physicians, ASCs, and hospitals, as well as payors, McKesson, Brookings Institute, and the Health Care Incentives Improvement Institute. Humana, a national payor with commercial, Medicare, TRICARE and Medicaid lines of business, provided the AGA with a de-identified patient claims data set covering commercial and Medicare patients and provided technical and clinical assistance in analyzing the data regarding the post-procedure period.

There are significant regional variations in colonoscopy site of service, preparation agent, sedation method, and surveillance follow-up intervals. Inconsistent interpretation of what constitutes a preventive service under the Affordable Care Act means that asymptomatic patients who receive CRC screening at a primary care level and found to have an abnormality requiring referral for colonoscopy may have financial responsibility for the diagnostic colonoscopy. Some payors waive patient responsibility for anesthesia and pathology obtained during colonoscopy as a preventive service, while others do not. Variation presents an opportunity to improve the quality and value of care, and a bundled payment model is one method to achieve that. Through negotiating a bundled payment for colonoscopy services, physicians could demonstrate their commitment to patient-friendly CRC services in advance of potential future changes in reimbursement.


Story Source:

The above story is based on materials provided by American Gastroenterological Association. Note: Materials may be edited for content and length.


Journal Reference:

  1. Joel V. Brill, Rajeev Jain, Peter S. Margolis, Lawrence R. Kosinski, Worthe S. Holt, Scott R. Ketover, Lawrence S. Kim, Laura E. Clote, John I. Allen. A Bundled Payment Framework for Colonoscopy Performed for Colorectal Cancer Screening or Surveillance. Gastroenterology, 2014; 146 (3): 849 DOI: 10.1053/j.gastro.2014.01.043

Cite This Page:

American Gastroenterological Association. "Bundled payments come to gastroenterology." ScienceDaily. ScienceDaily, 24 March 2014. <www.sciencedaily.com/releases/2014/03/140324133242.htm>.
American Gastroenterological Association. (2014, March 24). Bundled payments come to gastroenterology. ScienceDaily. Retrieved August 27, 2014 from www.sciencedaily.com/releases/2014/03/140324133242.htm
American Gastroenterological Association. "Bundled payments come to gastroenterology." ScienceDaily. www.sciencedaily.com/releases/2014/03/140324133242.htm (accessed August 27, 2014).

Share This




More Health & Medicine News

Wednesday, August 27, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Mini Pacemaker Has No Wires

Mini Pacemaker Has No Wires

Ivanhoe (Aug. 27, 2014) Cardiac experts are testing a new experimental device designed to eliminate major surgery and still keep the heart on track. Video provided by Ivanhoe
Powered by NewsLook.com
After Cancer: Rebuilding Breasts With Fat

After Cancer: Rebuilding Breasts With Fat

Ivanhoe (Aug. 27, 2014) More than 269 million women are diagnosed with breast cancer each year. Many of them will need surgery and radiation, but there’s a new simple way to reconstruct tissue using a patient’s own fat. Video provided by Ivanhoe
Powered by NewsLook.com
Blood Clots in Kids

Blood Clots in Kids

Ivanhoe (Aug. 27, 2014) Every year, up to 200,000 Americans die from a blood clot that travels to their lungs. You’ve heard about clots in adults, but new research shows kids can get them too. Video provided by Ivanhoe
Powered by NewsLook.com
Radio Waves Knock out Knee Pain

Radio Waves Knock out Knee Pain

Ivanhoe (Aug. 27, 2014) Doctors have used radio frequency ablation or RFA to reduce neck and back pain for years. But now, that same technique is providing longer-term relief for patients with severe knee pain. Video provided by Ivanhoe
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins