“ProvenCareSM”: A Provider-Driven Pay-for-Performance Program for Acute Episodic Cardiac Surgical Care

  title={“ProvenCareSM”: A Provider-Driven Pay-for-Performance Program for Acute Episodic Cardiac Surgical Care},
  author={Alfred S. Casale and Ronald A. Paulus and Mark J Selna and Michael C Doll and Albert Bothe and Karen E. McKinley and Scott A. Berry and Duane E Davis and Richard J Gilfillan and Bruce H. Hamory and Glenn D. Steele},
  journal={Annals of Surgery},
Objective:To test whether an integrated delivery system could successfully implement an evidence-based pay-for-performance program for coronary artery bypass graft (CABG) surgery. Methods:The program consisted of 3 components: (1) establishing implementable best practices; (2) developing risk-based pricing; (3) establishing a mechanism for patient engagement. Surgeons reviewed all class I and IIa “2004 American Heart Association/American College of Cardiology Guidelines for CABG Surgery” and… 
ProvenCare: quality improvement model for designing highly reliable care in cardiac surgery
Frontline medical care providers, led by process design specialists, can successfully redesign episodic processes to consistently deliver evidence-based medicine, which may improve patient outcomes and reduce resource use.
Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.
Feasibility and impact of an evidence-based program for gastric bypass surgery.
Pay for performance in the intensive care unit—Opportunity or threat?*
Participation in pay-for-performance programs is a potential opportunity for intensivists and ICU teams to improve outcomes for their patients in partnership with regulatory agencies and healthcare funders.
Care Processes Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement
A health system’s experience in developing and implementing a bundled payment program is described and its effects on quality and cost for patients under going Care Processes are examined.
Improving Cardiovascular Care Through Outpatient Cardiac Rehabilitation: An Analysis of Payment Models That Would Improve Quality and Promote Use
It is concluded 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.
Will Bundled Payments Change Health Care? Examining the Evidence Thus Far in Cardiovascular Care.
Episode-based, “bundled” payments have come to the forefront of the national discussion on combating rising healthcare costs, with its advocates arguing that it can curtail healthcare costs while simultaneously improving quality.
Bundled Payments in Cardiac Surgery: Is Risk Adjustment Sufficient to Make It Feasible?
Medicare's Bundled Payments for Care Improvement initiative: expanding enrollment suggests potential for large impact.
Growing participation in BPCI suggests strong interest in bundled payments, and the long-term impact of BPCi will depend on CMMI's ability to persuade interested but non-risk-bearing participants to bear risk.
Bundled Payments for Care Improvement
The experience of creating a system of response for the diverse people and diagnoses that fall into the medical DRG bundles is described and organizational factors for enabling successful implementation of bundled payments are identified.


Early experience with pay-for-performance: from concept to practice.
Paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.
A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group.
It is concluded that a multi-institutional, regional model for the continuous improvement of surgical care is feasible and effective and may have applications in other settings.
Potential benefits, limitations, and harms of clinical guidelines
The potential benefits, limitations, and harms of clinical guidelines are examined, a tool for making care more consistent and efficient and for closing the gap between what clinicians do and what scientific evidence supports.
ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery).
The major areas of change reflected in the update of the ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery are described in a format that can be read and understood as a stand-alone document.
Guidance on guidelines.
The role of guidelines in clinical practice and service development needs close examination, and studies suggest that guidelines emanating from consensus development conferences are unlikely to affect practice unless other factors promoting change are present.
Managing Clinical Knowledge for Health Care Improvement.
To improve the quality of health care that patients actually receive, both biomedical research production and especially its introduction into clinical practice need to be examined.
How good is the quality of health care in the United States?
Efforts to measure quality and report routinely on the results to the public at large would allow more definitive assessments of the status of the nation's health care and would enable us to single out the areas in need of improvement.
All-or-none measurement raises the bar on performance.
There are at least 3 different options for calculating performance on multiple, discretemeasures for the same condition, and Item-by-Item MeasurementPerformance on the provision of each element of care is re-ported separately asapercentage.