Episodes in action: linking the cost and quality of nonsurgical coronary revascularization.
By dissociating episodes into four types of risk (i.e., risk of occurrence, clinical risk, technical risk, and utility risk) financial incentives can be created that reward good clinical judgement, superior technical quality, and efficient health care delivery. Using a computer-generated simulation of 100,000 episodes of nonsurgical coronary revascularization (i.e., PTCA), global fees were assigned to each patient, and the relation between clinical performance and financial success was explored for 100 hypothetical practices. Good sensitivity and specificity were achieved in assessing clinical performance. Financial incentives were found to favor providers of appropriate, effective, and efficient care.
Pine
M
M
Michael Pine and Associates, Inc., University of Chicago, Chicago, Illinois, USA.
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics* / Q000592:standards*; D003198:Computer Simulation; D017050:Episode of Care; D017048:Health Care Costs; D006801:Humans; D016365:Liability, Legal / Q000191:economics; D008329:Managed Care Programs / Q000191:economics; D011785:Quality Assurance, Health Care; D012052:Reimbursement, Incentive; D020379:Risk Adjustment; D014481:United States