Bundled payment for actinic keratosis management: Pilot evaluation of developed models

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Abstract

Background: There is an opportunity to explore alternate payment models in dermatology. Objective: To pilot 2 bundled payment models for actinic keratosis (AK) management. Methods: A prospective cohort study was conducted during September 2013-June 2016. Consecutive patients were recruited from clinics of 5 dermatologists. Patients had to be adults, have ≥1 year of care at the department, and have a history of AK. A bundled payment strategy was prospectively piloted for 1 year and compared with costs in the prior year. Results: Overall, 400 participants were enrolled, and complete data was collected for 254 participants. During the year of bundled payments, actual total annual spending on claims was $70,557, whereas model 1 and model 2 bundled payment models would have totaled $67,310 and $74,422, respectively, for the patient cohort. Patient satisfaction surveys showed no difference in the quality of care. Limitations: Single-center study and limited sample size. International Classification of Diseases 9 and 10 codes were used to identify claims and might be inaccurate. Costs were modeled rather than fully implemented. Conclusion: Dermatologists should be aware of bundled payment models. More work is needed to elucidate the optimal formulation of a bundled payment for AK management, including the services covered, time delimitation, and risk stratification factors.

Original languageEnglish (US)
Pages (from-to)679-684
Number of pages6
JournalJournal of the American Academy of Dermatology
Volume80
Issue number3
DOIs
StatePublished - Mar 1 2019

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Actinic Keratosis
Costs and Cost Analysis
Quality of Health Care
International Classification of Diseases
Dermatology
Patient Satisfaction
Sample Size
Cohort Studies
Prospective Studies
Dermatologists

All Science Journal Classification (ASJC) codes

  • Dermatology

Cite this

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title = "Bundled payment for actinic keratosis management: Pilot evaluation of developed models",
abstract = "Background: There is an opportunity to explore alternate payment models in dermatology. Objective: To pilot 2 bundled payment models for actinic keratosis (AK) management. Methods: A prospective cohort study was conducted during September 2013-June 2016. Consecutive patients were recruited from clinics of 5 dermatologists. Patients had to be adults, have ≥1 year of care at the department, and have a history of AK. A bundled payment strategy was prospectively piloted for 1 year and compared with costs in the prior year. Results: Overall, 400 participants were enrolled, and complete data was collected for 254 participants. During the year of bundled payments, actual total annual spending on claims was $70,557, whereas model 1 and model 2 bundled payment models would have totaled $67,310 and $74,422, respectively, for the patient cohort. Patient satisfaction surveys showed no difference in the quality of care. Limitations: Single-center study and limited sample size. International Classification of Diseases 9 and 10 codes were used to identify claims and might be inaccurate. Costs were modeled rather than fully implemented. Conclusion: Dermatologists should be aware of bundled payment models. More work is needed to elucidate the optimal formulation of a bundled payment for AK management, including the services covered, time delimitation, and risk stratification factors.",
author = "{Sciacca Kirby}, Joslyn and Silva, {Colleen F.} and Sara Ferguson and David Shupp and James Marks and Jeffrey Miller",
year = "2019",
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AU - Ferguson, Sara

AU - Shupp, David

AU - Marks, James

AU - Miller, Jeffrey

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N2 - Background: There is an opportunity to explore alternate payment models in dermatology. Objective: To pilot 2 bundled payment models for actinic keratosis (AK) management. Methods: A prospective cohort study was conducted during September 2013-June 2016. Consecutive patients were recruited from clinics of 5 dermatologists. Patients had to be adults, have ≥1 year of care at the department, and have a history of AK. A bundled payment strategy was prospectively piloted for 1 year and compared with costs in the prior year. Results: Overall, 400 participants were enrolled, and complete data was collected for 254 participants. During the year of bundled payments, actual total annual spending on claims was $70,557, whereas model 1 and model 2 bundled payment models would have totaled $67,310 and $74,422, respectively, for the patient cohort. Patient satisfaction surveys showed no difference in the quality of care. Limitations: Single-center study and limited sample size. International Classification of Diseases 9 and 10 codes were used to identify claims and might be inaccurate. Costs were modeled rather than fully implemented. Conclusion: Dermatologists should be aware of bundled payment models. More work is needed to elucidate the optimal formulation of a bundled payment for AK management, including the services covered, time delimitation, and risk stratification factors.

AB - Background: There is an opportunity to explore alternate payment models in dermatology. Objective: To pilot 2 bundled payment models for actinic keratosis (AK) management. Methods: A prospective cohort study was conducted during September 2013-June 2016. Consecutive patients were recruited from clinics of 5 dermatologists. Patients had to be adults, have ≥1 year of care at the department, and have a history of AK. A bundled payment strategy was prospectively piloted for 1 year and compared with costs in the prior year. Results: Overall, 400 participants were enrolled, and complete data was collected for 254 participants. During the year of bundled payments, actual total annual spending on claims was $70,557, whereas model 1 and model 2 bundled payment models would have totaled $67,310 and $74,422, respectively, for the patient cohort. Patient satisfaction surveys showed no difference in the quality of care. Limitations: Single-center study and limited sample size. International Classification of Diseases 9 and 10 codes were used to identify claims and might be inaccurate. Costs were modeled rather than fully implemented. Conclusion: Dermatologists should be aware of bundled payment models. More work is needed to elucidate the optimal formulation of a bundled payment for AK management, including the services covered, time delimitation, and risk stratification factors.

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