The Current State of Evidence on Bundled Payments

A review of the evidence shows that bundled payments for surgical procedures can generate savings without adversely affecting patient outcomes. Less is known about the effect of bundled payments for chronic medical conditions, but early evidence suggests that cost and quality improvements may be small or non-existent. There is little evidence that bundles reduce access and equity, but continued monitoring is required

The Future of Value-Based Payment

A decade of innovation and experimentation has failed to transform the health care system to one that pays for value rather than volume. It is now time to reconsider how value-based payment models can generate substantial savings and improve quality and health equity. Experts from the University of Pennsylvania, with input from a national panel of experts, reviewed the effectiveness of past payment reforms implemented by the Centers for Medicare and Medicaid Services (CMS) and made recommendations about how to accelerate and complete the nation’s transformation to value-based payment. This brief summarizes recommendations that provide a path toward widespread adoption and success of alternative payment models, producing better health outcomes for all Americans, reducing wasteful spending, improving health equity, and more effectively stewarding taxpayer funds to support other national priorities

The formation of surgeon peer reputation and its effect on technology adoption

In this dissertation, I study the mechanism through which surgeons accumulate peer reputation by signaling quality and its implications for their pace of technology adoption. Peer physicians make attributions about surgeon quality by disproportionately weighting an outcome\u27s signal by its likelihood (nonlinear weighting). This attribution behavior creates an incentive for surgeons to actively manage case-mix. Empirical analysis supports the theoretical predictions that succeeding builds volume faster on difficult cases than on easy cases and failing depletes it more rapidly on easy cases than on difficult cases. A counterintuitive prediction also shown empirically is that case-mix decreases with increasing peer reputation. The final piece of theoretical analysis demonstrates, also counterintuitively, that high reputation surgeons will adopt more quickly than low reputation surgeons. In the empirical analysis, I find strong supportive evidence that surgeons with low severity case-mix adopt the new technology more rapidly. The policy implications include the need for physician groups to institute swift guidelines regarding adoption of new technologies and reconsideration of the information given in report cards. Furthermore, organizations should account for surgeons\u27 private incentives in managing case allocation

The formation of surgeon peer reputation and its effect on technology adoption

In this dissertation, I study the mechanism through which surgeons accumulate peer reputation by signaling quality and its implications for their pace of technology adoption. Peer physicians make attributions about surgeon quality by disproportionately weighting an outcome\u27s signal by its likelihood (nonlinear weighting). This attribution behavior creates an incentive for surgeons to actively manage case-mix. Empirical analysis supports the theoretical predictions that succeeding builds volume faster on difficult cases than on easy cases and failing depletes it more rapidly on easy cases than on difficult cases. A counterintuitive prediction also shown empirically is that case-mix decreases with increasing peer reputation. The final piece of theoretical analysis demonstrates, also counterintuitively, that high reputation surgeons will adopt more quickly than low reputation surgeons. In the empirical analysis, I find strong supportive evidence that surgeons with low severity case-mix adopt the new technology more rapidly. The policy implications include the need for physician groups to institute swift guidelines regarding adoption of new technologies and reconsideration of the information given in report cards. Furthermore, organizations should account for surgeons\u27 private incentives in managing case allocation

The Formation of Peer Reputation among Physicians and Its Effect on Technology Adoption

This paper studies patient volume and the severity of case mix as they relate to physicians' human capital accumulation and pace of technology adoption by exploring a quality signaling mechanism through which physicians build peer reputation. We show that volume building leads physicians to actively manage case mix and find that successful surgeries (particularly for difficult cases) raise future volume, whereas failed surgeries (particularly for easy cases) deplete it. Surgeons with a high patient census and a low-severity case mix adopt the new technology more rapidly. These findings highlight the role of peer reputation for growing practice size and the timing of technology adoption. (c) 2009 by The University of Chicago. All rights reserved..