Price Transparency in Health Care: The Other Half of the Value Equation

David B. Bumpass, MD; Julie Balch Samora, MD, PhD, MPH

Healthcare reform is increasingly centered on value, defined as quality delivered per unit cost. Since passage of the Patient Protection & Affordable Care Act (ACA) in 2010, the quality reporting landscape has been dramatically altered and expanded in both the public and private sectors. The goal of these efforts has been to increase the volume of accurate quality and outcomes data, making it available to patients, insurers, and health providers in a usable form.

Measuring the Success of Bundled Pricing Models

Ross Taylor, MD, MBA

Because bundled pricing involves a single payment to provider organizations for a surgical service such as joint replacement, there are no contingency payments for prolonged hospital stays, hospital readmissions, or carve-out payments for implants. This forces providers to consider the factors that determine the cost of providing care (cost drivers) during an orthopaedic episode.

The Impact of Payment Strategies on Retail Health Care

Alexandra E. Page, MD

Alexandra E. Page, MD The commercial market for health care has changed considerably in the wake of healthcare reform and the passage of the Affordable Care Act. Employers seeking to control costs are increasing deductible and copayments for employees; to deal with these higher out-of-pocket expenses, employees are seeking the highest value for their healthcare dollars, including such “value-added” services such as longer office hours, convenient locations, or other benefits beyond cost.

Physicians Redouble Efforts to Have SGR Repealed

Elizabeth Fassbender

AAOS schedules actual, virtual “fly-in” next month Elizabeth Fassbender One of the last actions taken by the 113th Congress was to pass a $1.1 trillion budget deal that closely averted another government shutdown.

Second Look—Advocacy

HIPAA privacy provisions In response to Ebola outbreak concerns, the U.S. Department of Health and Human Services (HHS) has issued a bulletin regarding Health Insurance Portability and Accountability Act (HIPAA) rules in emergency conditions. HHS states that if the president of the United States announces an emergency, the secretary of HHS may waive certain provisions under the Project Bioshield Act of 2004 and section 1135(b)(7) of the Social Security Act.

CMS Converting All Global Payments for Procedural Services to Zero Days

R. Dale Blasier, MD

In the 2015 Physician Fee Schedule (PFS) Final Rule, released Oct. 31, 2014, the Centers for Medicare and Medicaid Services (CMS) confirmed its intention to convert all 10- and 90-day global procedure codes to 0-day global codes. According to the Final Rule, CMS believes “it is critical that the relative value units (RVUs) under the PFS be based as closely and accurately as possible on the actual resources involved in furnishing the typical occurrence of specific services.”