title: Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.
abstract: BACKGROUND
  Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use.
  
  
  OBJECTIVE
  The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR.
  
  
  CONCLUSIONS
  We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment.
  
  
  CONCLUSIONS
  Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.
authors: Holly Mead, PhD Assistant Professor, Department of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC. Sarah Grantham, MHS Research Assistant, Department of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC. Bruce Siegel, MD, MPH Research Pofessor and Drector, Center for Health Care Quality, Department of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC.
authors: Holly
authors: H
authors: Mead
authors: Sarah
authors: S
authors: Grantham
authors: Bruce
authors: B
authors: Siegel
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000191:economics; D001026:Coronary Artery Bypass / Q000191:economics; D003324:Coronary Artery Disease / Q000191:economics / Q000534:rehabilitation*; D017050:Episode of Care; D006801:Humans; D006278:Medicare; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D012046:Rehabilitation / Q000191:economics / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms; D012052:Reimbursement, Incentive; D055502:Secondary Prevention; D014481:United States