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Introduction: In the Netherlands, bundled payments were introduced as part of a strategy to redesign chronic care delivery. Under this strategy new entities of health care providers in primary care are negotiating with health insurers about the price for a bundle of services for several chronic conditions. This study evaluates the level of involvement of primary health care dietitians in these entities and the experienced advantages and disadvantages., Methods: In August 2011, a random sample of 800 Dutch dietitians were invited by email to complete an online questionnaire (net response rate 34%)., Results: Two-thirds participated in a diabetes disease management programme, mostly for diabetes care, financed by bundled payments (n=130). Positive experiences of working in these programmes were an increase in: multidisciplinary collaboration (68%), efficiency of health care (40%) and transparency of health care quality (25%). Negative aspects were an increase in administrative tasks (61%), absence of payment for patients with comorbidity (38%) and concerns about substitution of care (32%)., Discussion/conclusion: Attention is needed for payment of patients with co- or multi-morbidity within the bundled fee. Substitution of dietary care by other disciplines needs to be further examined since it may negatively affect the quality of treatment. Task delegation and substitution of care may require other competencies from dietitians. Further development of coaching and negotiation skills may help dietitians prepare for the future.

Background: Although accountable care organizations (ACOs) are rapidly being deployed in Medicare, little is known about how the model might affect high-risk, high cost groups such as cancer patients. The Physician Group Practice Demonstration, which ran from 2005 to 2010 in 10 physician groups, provides the best current evidence on the likely effectiveness of accountable care organizations for Medicare beneficiaries. Changes in cancer treatment and spending under this program may be indicative of cancer treatment under ACO payment reform., Methods: Using Medicare fee-for-service claims data, regression analysis was used to estimate changes in payments for cancer patients using a difference-in-difference design comparing pre- (2001-2004) and post-intervention (2005-2009) trends in spending on cancer patients in PGPD participants to local control groups., Results: Regression models indicate the Physician Group Practice Demonstration was associated with average Medicare spending reductions per cancer patient of $721 annually across participating sites, an annual 3.9% reduction in payments per patient. Savings derived entirely from reductions in acute care payments for inpatient stays. The Demonstration was also associated with a reduction in mortality among cancer patients. There was no significant change in the proportion of deaths occurring in the hospital. There were significant reductions in hospice use, hospital discharges and ICU days, but no reductions in cancer-specific procedures or chemotherapy. Estimates of all measures varied considerably across participating sites., Conclusions: The Physician Group Practice Demonstration was associated with reductions in admissions for inpatient care among beneficiaries with prevalent cancer, with no adverse effect on mortality. Participants in the Physician Group Practice Demonstration did not change the trajectory of spending for cancer-specific treatments., Implications: Inpatient care for beneficiaries with cancer may represent a significant source of potential savings for ACOs, but evidence from the Physician Group Practice Demonstration indicates that no changes were made to cancer treatments such as chemotherapy or surgical procedures.

Transformations in care delivery and payment models that make care more efficient are leading some to question whether there will really be a shortage of primary care physicians. While it is encouraging to see numerous federal and state policy levers in place to support greater accountability and coordination of care, it is too early to know whether these efforts will change current and future primary care physician workforce needs. More research is needed to inform whether efforts to reduce cost and improve quality of care and population health will help alleviate or further exacerbate expected primary care physician shortages., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Reforming China's public hospitals to curb widespread overtreatment and improve the quality and affordability of care has been the most challenging aspect of that nation's ambitious health reform, which began in 2009. This article describes a pilot project under way in several of China's provinces that combines payment reform with the implementation of evidence-based clinical pathways at a few hospitals serving rural areas. Results to date include reduced length-of-stay and prescription drug use and higher patient and provider satisfaction. These early results suggest that the pilot may be achieving its goals, which may have far-reaching and positive implications for China's ongoing reform.

Current Medicare payment policy for outpatient laboratory services is outdated. Future reforms, such as competitive bidding, should consider the characteristics of the laboratory market. To inform payment policy, we analyzed the structure of the national market for Medicare Part B clinical laboratory testing, using a 5-percent sample of 2006 Medicare claims data. The independent laboratory market is dominated by two firms--Quest Diagnostics and Laboratory Corporation of America. The hospital outreach market is not as concentrated as the independent laboratory market. Two subgroups of Medicare beneficiaries, those with end-stage renal disease and those residing in nursing homes, are each served in separate laboratory markets. Despite the concentrated independent laboratory market structure, national competitive bidding for non-patient laboratory tests could result in cost savings for Medicare.