Market Evaluation: Finances, Bundled Payments, and Accountable Care Organizations

Abstract

To control costs and improve quality, changes in health care delivery and financing have emerged, resulting in shifting of financial risk to providers for the quality and cost of care, including emergence of accountable care organizations and bundled payment models. This article discusses health care financing and delivery models in the context of procedures and surgeries that happen outside of the operating room. It describes the history of health insurance, trends in ambulatory surgery centers, and new payment models that have emerged from the Affordable Care Act and the Medicare Access and Children's Health Insurance Program Reauthorization Act.

Keywords: Accountable care organizations; Anesthesia; Bundled payments; Health care; Health economics.

Fig. 1.

National health expenditure spending: 1960 to 2015. (Data from Centers for Medicare & Medicaid Services. National Health Expenditure Data. NHE Fact Sheet. Available at: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html. Accessed January 13, 2017.)

Fig. 2.

Specialty category by volume, CY 2009 ASC claims. ASC, ambulatory surgical center; CY, calendar year. (Data from U.S. Department of Health and Human Services. Report to Congress: Medicare Ambulatory Surgical Center Value-Based Purchasing Implementation Plan. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/Downloads/C_ASC_RTC-2011.pdf. Accessed January 26, 2017.)

Fig. 3.

Spectrum of provider payment models.