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首页> 外文期刊>Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association >Shifting Away From Fee-For-Service: Alternative Approaches to Payment in Gastroenterology
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Shifting Away From Fee-For-Service: Alternative Approaches to Payment in Gastroenterology

机译：摆脱按服务付费：胃肠病学的替代付款方式

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摘要

Fee-for-service payments encourage high-volume services rather than high-quality care. Alternative payment models (APMs) aim to realign financing to support high-value services. The 2 main components of gastroenterologic care, procedures and chronic care management, call for a range of APMs. The first step for gastroenterologists is to identify the most important conditions and opportunities to improve care and reduce waste that do not require financial support. We describe examples of delivery reforms and emerging APMs to accomplish these care improvements. A bundled payment for an episode of care, in which a provider is given a lump sum payment to cover the cost of services provided during the defined episode, can support better care for a discrete procedure such as a colonoscopy. Improved management of chronic conditions can be supported through a per-member, per-month (PMPM) payment to offer extended services and care coordination. For complex chronic conditions such as inflammatory bowel disease, in which the gastroenterologist is the principal care coordinator, the PMPM payment could be given to a gastroenterology medical home. For conditions in which the gastroenterologist acts primarily as a consultant for primary care, such as noncomplex gastroesophageal reflux or hepatitis C, a PMPM payment can support effective care coordination in a medical neighborhood delivery model. Each APM can be supplemented with a shared savings component. Gastroenterologists must engage with and be early leaders of these redesign discussions to be prepared for a time when APMs may be more prevalent and no longer voluntary.
机译：按服务付费是鼓励大批量服务而不是高质量护理。替代支付模式（APM）旨在重新调整融资以支持高价值服务。胃肠病护理，程序和慢性护理管理这两个主要组成部分要求一系列APM。肠胃科医生的第一步是确定最重要的条件和机会，以改善护理水平并减少不需要资金支持的废物。我们描述了实现这些护理改善的分娩改革和新兴APM的示例。捆绑式护理费用，其中向提供者提供一次性付款，以支付在定义的护理期间提供的服务费用，可以为更好的护理提供支持，例如结肠镜检查。可以通过按会员，每月（PMPM）支付费用来改善慢性病管理，以提供扩展服务和护理协调。对于复杂的慢性疾病，例如肠胃炎是肠胃病的主要护理协调员，例如炎症性肠病，可以将PMPM的费用支付给肠胃病医疗之家。对于胃肠病科医生主要充当初级保健顾问的情况，例如非复杂性胃食管反流或丙型肝炎，PMPM支付可以支持在医疗邻里分娩模型中进行有效的护理协调。每个APM可以补充一个共享的节省部分。胃肠病学家必须与这些重新设计的讨论接触并成为其早期领导者，以准备在APM可能更普遍且不再自愿的时候进行。

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