案例库 · 财务与会计 · 财务决策 · 2018–2024
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CMS paid hospitals one price for an episode, so savings stayed shared with Medicare
BPCI Advanced gave hospitals a fixed target price per episode, and participants cut episode spending and kept a share.
Centers for Medicare & Medicaid Services · participating US hospitals · Medicare
那一手
Traditional fee-for-service pays per service, rewarding more care even when it adds no value.
BPCI Advanced sets a target price for a full clinical episode, including the 90 days after discharge.
Hospitals that stay under target share the savings with Medicare; those over target repay.
This shifts the financial incentive from volume to the cost and quality of the entire episode.
为什么管用
- One price per episode makes the hospital own the whole care path.
- Savings-sharing rewards coordination rather than extra services.
- The repayment risk is symmetric, so cost control is not one-sided.
- Quality of care is measured alongside cost, not traded off for it.
可以搬走什么
To move providers from volume to value, price the whole outcome and let them share the savings — the unit of payment changes the behaviour.
后来呢
In Model Year 5, BPCI Advanced generated about $344 million in savings to Medicare (roughly 4% of what payments would otherwise have been). Earlier model years had net losses, and later analysis showed per-episode reductions averaging about $324, tempering claims that the program reliably saved money.
资料来源
- BPCI Advanced Model: Sixth Annual Evaluation Report
- TEAM Strategy: Lessons from 6th Annual BPCI-A Evaluation Report
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