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Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care.

Publication ,  Journal Article
Wang, CJ; Cheng, SH; Wu, J-Y; Lin, Y-P; Kao, W-H; Lin, C-L; Chen, Y-J; Tsai, S-L; Kao, F-Y; Huang, AT
Published in: JAMA Oncol
March 1, 2017

IMPORTANCE: Value-driven payment system reform is a potential tool for aligning economic incentives with the improvement of quality and efficiency of health care and containment of cost. Such a payment system has not been researched satisfactorily in full-cycle cancer care. OBJECTIVE: To examine the association of outcomes and medical expenditures with a bundled-payment pay-for-performance program for breast cancer in Taiwan compared with a fee-for-service (FFS) program. DESIGN, SETTING, AND PARTICIPANTS: Data were obtained from the Taiwan Cancer Database, National Health Insurance Claims Data, the National Death Registry, and the bundled-payment enrollment file. Women with newly diagnosed breast cancer and a documented first cancer treatment from January 1, 2004, to December 31, 2008, were selected from the Taiwan Cancer Database and followed up for 5 years, with the last follow-up data available on December 31, 2013. Patients in the bundled-payment program were matched at a ratio of 1:3 with control individuals in an FFS program using a propensity score method. The final sample of 17 940 patients included 4485 (25%) in the bundled-payment group and 13 455 (75%) in the FFS group. MAIN OUTCOMES AND MEASURES: Rates of adherence to quality indicators, survival rates, and medical payments (excluding bonuses paid in the bundled-payment group). The Kaplan-Meier method was used to calculate 5-year overall and event-free survival rates by cancer stage, and the Cox proportional hazards regression model was used to examine the effect of the bundled-payment program on overall and event-free survival. Sensitivity analysis for bonus payments in the bundled-payment group was also performed. RESULTS: The study population included 17 940 women (mean [SD] age, 52.2 [10.3] years). In the bundled-payment group, 1473 of 4215 patients (34.9%) with applicable quality indicators had full (100%) adherence to quality indicators compared with 3438 of 12 506 patients (27.5%) with applicable quality indicators in the FFS group (P < .001). The 5-year event-free survival rates for patients with stages 0 to III breast cancer were 84.48% for the bundled-payment group and 80.88% for the FFS group (P < .01). Although the 5-year medical payments of the bundled-payment group remained stable, the cumulative medical payments for the FFS group steadily increased from $16 000 to $19 230 and exceeded pay-for-performance bundled payments starting in 2008. CONCLUSIONS AND RELEVANCE: In Taiwan, compared with the regular FFS program, bundled payment may lead to better adherence to quality indicators, better outcomes, and more effective cost-control over time.

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Published In

JAMA Oncol

DOI

EISSN

2374-2445

Publication Date

March 1, 2017

Volume

3

Issue

3

Start / End Page

327 / 334

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Taiwan
  • Survival Analysis
  • Reimbursement Mechanisms
  • Registries
  • Quality of Health Care
  • Practice Guidelines as Topic
  • Patient Care Bundles
  • Middle Aged
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Wang, C. J., Cheng, S. H., Wu, J.-Y., Lin, Y.-P., Kao, W.-H., Lin, C.-L., … Huang, A. T. (2017). Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care. JAMA Oncol, 3(3), 327–334. https://doi.org/10.1001/jamaoncol.2016.4549
Wang, C Jason, Skye H. Cheng, Jen-You Wu, Yi-Ping Lin, Wen-Hsin Kao, Chia-Li Lin, Yin-Jou Chen, Shu-Ling Tsai, Feng-Yu Kao, and Andrew T. Huang. “Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care.JAMA Oncol 3, no. 3 (March 1, 2017): 327–34. https://doi.org/10.1001/jamaoncol.2016.4549.
Wang CJ, Cheng SH, Wu J-Y, Lin Y-P, Kao W-H, Lin C-L, et al. Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care. JAMA Oncol. 2017 Mar 1;3(3):327–34.
Wang, C. Jason, et al. “Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care.JAMA Oncol, vol. 3, no. 3, Mar. 2017, pp. 327–34. Pubmed, doi:10.1001/jamaoncol.2016.4549.
Wang CJ, Cheng SH, Wu J-Y, Lin Y-P, Kao W-H, Lin C-L, Chen Y-J, Tsai S-L, Kao F-Y, Huang AT. Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care. JAMA Oncol. 2017 Mar 1;3(3):327–334.

Published In

JAMA Oncol

DOI

EISSN

2374-2445

Publication Date

March 1, 2017

Volume

3

Issue

3

Start / End Page

327 / 334

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Taiwan
  • Survival Analysis
  • Reimbursement Mechanisms
  • Registries
  • Quality of Health Care
  • Practice Guidelines as Topic
  • Patient Care Bundles
  • Middle Aged
  • Humans