NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Hussey PS, Mulcahy AW, Schnyer C, et al. Closing the Quality Gap: Revisiting the State of the Science (Vol. 1: Bundled Payment: Effects on Health Care Spending and Quality). Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Aug. (Evidence Reports/Technology Assessments, No. 208.1.)

Cover of Closing the Quality Gap: Revisiting the State of the Science (Vol. 1: Bundled Payment: Effects on Health Care Spending and Quality)

Closing the Quality Gap: Revisiting the State of the Science (Vol. 1: Bundled Payment: Effects on Health Care Spending and Quality).

Show details


Gosden T, Forland F, Kristiansen IS, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database of Systematic Reviews. 2000;(No. 3) (Review) [PubMed: 10908531]
Miller HD. From Volume To Value: Better Ways To Pay For Health Care. Health Aff. 2009 Sept 1;28(5):1418–28. [PubMed: 19738259]
Congressional Budget Office. Key issues in analyzing major health insurance proposals. 2008. Available at: www​​/files/cbofiles​/ftpdocs/99xx/doc9924/toc.shtml.
Schneider EC, Hussey PS, Schnyer C. Payment Reform: Analysis of Models and Performance Measurement Implications. RAND Corporation; Santa Monica, CA: 2010.
Rosenthal MB. Beyond Pay for Performance—Emerging Models of Provider-Payment Reform. New England Journal of Medicine. 2008 Sept 18;359(12):1197–200. [PubMed: 18799554]
Medicare Payment Advisory Commission. Report to the Congress: Reforming the Delivery System. MedPAC; Washington, DC: Jun, 2008.
Goldsmith J. Analyzing Shifts In Economic Risks To Providers In Proposed Payment And Delivery System Reforms. Health Affairs. 2010;29(7):1299–304. [PubMed: 20606177]
Corrigan J, McNeill D. Building Organizational Capacity: A Cornerstone Of Health System Reform. Health Affairs. 2009 Mar 1;28(2):w205–w15. 2009. [PubMed: 19174381]
Dudley R, Frolich A, Robinowitz D, et al. Strategies To Support Quality-based Purchasing: A Review of the Evidence. Stanford-University of California San Francisco Evidence-based Practice Center; Rockville, MD: 2004.
Andersen RM. Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior. 1995;36(1):1–10. [PubMed: 7738325]
Agency for Healthcare Research and Quality. Methods Reference Manual for Comparative Effectiveness Reviews. Rockville, MD: 2007.
Atkins D, Chang S, Gartlehner G, et al. Assessing the Applicability of Studies When Comparing Medical Interventions. Agency for Healthcare Research and Quality; Jan, 2011.
Cheh V. The Final Evaluation Report on the National Home Health Prospective Payment Demonstration: Agencies Reduce Visits While Preserving Quality. Mathematica Policy Research, Inc.; Princeton, NJ: Apr 30, 2001.
Centers for Medicare and Medicaid Services. Acute Care Episode Demonstration Fact Sheet. 2009. [February 20, 2012]. https://www​​/downloads/ACEFactSheet.pdf.
Centers for Medicare and Medicaid Services. Bundled Payments for Care Improvement home page. 2011. [February 20, 2012]. http://innovations​.cms​.gov/initiatives/bundled-payments/
Hussey PS, Rosenthal MB, Ridgely MS. The PROMETHEUS Bundled Payment Experiment: Slow Start Shows Problems In Implementing New Payment Models. Health Aff. 2011;30(11):2116–24. [PubMed: 22068404]
Chulis GS. Assessing Medicare's prospective payment system for hospitals. Med Care Rev. 1991 Summer;48(2):167–206. [PubMed: 10113662]
Coulam R, Gaumer G. Medicare's Prospective Payment System: A Critical Appraisal. Health Care Financing Review Annual Supplement. 1991;13(2):45–77. [PubMed: 10128704]
Feinglass J, Holloway JJ. The initial impact of the Medicare prospective payment system on U.S. health care: a review of the literature. Med Care Rev. 1991 Spring;48(1):91–115. [PubMed: 10113596]
Lave JR. The effect of the Medicare prospective payment system. Annu Rev Public Health. 1989;10:141–61. [PubMed: 2655628]
Afendulis CC, Kessler DP. Vertical integration and optimal reimbursement policy. Int J Health Care Finance Econ. 2011;2011(11):165–79. [PMC free article: PMC3195424] [PubMed: 21850551]
Buntin MB, Colla CH, Escarce JJ. Effects of payment changes on trends in post-acute care. Health Serv Res. 2009 Aug;44(4):1188–210. [PMC free article: PMC2739024] [PubMed: 19490159]
Chen LW, Shea DG. Does prospective payment really contain nursing home costs? Health Serv Res. 2002 Apr;37(2):251–71. [PMC free article: PMC1430360] [PubMed: 12035993]
Collins T, Herness J, Martenas J, et al. Medicare prospective payment before and after implementation: a review of visits and physical performance among Medicare home health patients after total knee replacements. Home Healthc Nurse. 2007 Jun;25(6):401–7. [PubMed: 17556923]
Grabowski DC, Afendulis CC, McGuire TG. Medicare prospective payment and the volume and intensity of skilled nursing facility services. J Health Econ. 2011 Jun 6 [PMC free article: PMC3151304] [PubMed: 21705100]
Hutt E, Ecord M, Eilertsen TB, et al. Prospective payment for nursing homes increased therapy provision without improving community discharge rates. Journal of the American Geriatrics Society. 2001:1071–9. [PubMed: 11555069]
Konetzka R, Norton E, Sloane P, et al. Medicare Prospective Payment and Quality of Care for Long-Stay Nursing Facility Residents. Medical Care. 2006;44(3):270–6. [PubMed: 16501399]
Konetzka R, Norton E, Stearns S. Medicare payment changes and nursing home quality: effects on long-stay residents. Int J Health Care Finance Econ. 2006;6(3):173–89. [PubMed: 17016764]
Konetzka R, Yi D, Norton E, et al. Effects of Medicare Payment Changes on Nursing Home Staffing and Deficiencies. Health Services Research. 2004;39(3):463–87. [PMC free article: PMC1361020] [PubMed: 15149474]
Kulesher RR, Wilder MG. Prospective payment and the provision of post-acute care: how the provisions of the Balanced Budget Act of 1997 altered utilization patterns for Medicare providers. J Health Care Finance. 2006 Fall;33(1):1–16. [PubMed: 21110487]
Lapane KL, Hughes CM. An evaluation of the impact of the prospective payment system on antidepressant use in nursing home residents. Med Care. 2004 Jan;42(1):48–58. [PubMed: 14713739]
Lapane KL, Hughes CM. Did the introduction of a prospective payment system for nursing home stays reduce the likelihood of pharmacological management of secondary ischaemic stroke? Drugs Aging. 2006;23(1):61–9. [PubMed: 16492070]
Murray PK, Love TE, Dawson NV, et al. Rehabilitation services after the implementation of the nursing home prospective payment system: differences related to patient and nursing home characteristics. Med Care. 2005 Nov;43(11):1109–15. [PubMed: 16224304]
White C. Rehabilitation therapy in skilled nursing facilities: effects of Medicare's new prospective payment system. Health Aff (Millwood) 2003 May-Jun;22(3):214–23. [PubMed: 12757287]
White C. Medicare's prospective payment system for skilled nursing facilities: effects on staffing and quality of care. Inquiry. 2005 Winter;42(4):351–66. [PubMed: 16568928]
Wodchis WP. Physical rehabilitation following medicare prospective payment for skilled nursing facilities. Health Serv Res. 2004 Oct;39(5):1299–318. [PMC free article: PMC1361071] [PubMed: 15333110]
Wodchis WP, Fries BE, Hirth RA. The effect of Medicare's prospective payment system on discharge outcomes of skilled nursing facility residents. Inquiry. 2004 Winter;41(4):418–34. [PubMed: 15835600]
Yip JY, Wilber KH, Myrtle RC. The impact of the 1997 Balanced Budget Amendment's prospective payment system on patient case mix and rehabilitation utilization in skilled nursing. Gerontologist. 2002 Oct;42(5):653–60. [PubMed: 12351800]
Zhang NJ, Unruh L, Wan TT. Has the Medicare prospective payment system led to increased nursing home efficiency? Health Serv Res. 2008 Jun;43(3):1043–61. [PMC free article: PMC2442238] [PubMed: 18454780]
Zinn J, Feng Z, Mor V, et al. Restructuring in response to case mix reimbursement in nursing homes: a contingency approach. Health Care Manage Rev. 2008 Apr-Jun;33(2):113–23. [PMC free article: PMC3731751] [PubMed: 18360162]
Dobrez D, Heinemann AW, Deutsch A, et al. Impact of Medicare's prospective payment system for inpatient rehabilitation facilities on stroke patient outcomes. Am J Phys Med Rehabil. 2010 Mar;89(3):198–204. [PubMed: 20068431]
Frymark TB, Mullen RC. Influence of the prospective payment system on speech-language pathology services. Am J Phys Med Rehabil. 2005 Jan;84(1):12–21. [PubMed: 15632484]
DeJong G, Horn SD, Smout RJ, et al. The early impact of the inpatient rehabilitation facility prospective payment system on stroke rehabilitation case mix, practice patterns, and outcomes. Arch Phys Med Rehabil. 2005 Dec;86(12 Suppl 2):S93–S100. [PubMed: 16373144]
Gillen R, Tennen H, McKee T. The impact of the inpatient rehabilitation facility prospective payment system on stroke program outcomes. Am J Phys Med Rehabil. 2007 May;86(5):356–63. [PubMed: 17449980]
McCue MJ, Thompson JM. Early effects of the prospective payment system on inpatient rehabilitation hospital performance. Arch Phys Med Rehabil. 2006 Feb;87(2):198–202. [PubMed: 16442972]
Paddock SM, Escarce JJ, Hayden O, et al. Did the Medicare inpatient rehabilitation facility prospective payment system result in changes in relative patient severity and relative resource use? Med Care. 2007 Feb;45(2):123–30. [PubMed: 17224774]
Qu H, Shewchuk RM, Chen Y, et al. Impact of Medicare prospective payment system on acute rehabilitation outcomes of patients with spinal cord injury. Arch Phys Med Rehabil. 2011 Mar;92(3):346–51. [PubMed: 21353819]
Shah P, Heinemann A, Manheim L. The Effect of Medicare's Prospective Payment System on Patient Satisfaction: An Illustration with Four Rehabilitation Hospitals. Am J Phys Med Rehabil. 2007;86(3):169–75. [PubMed: 17314702]
Sood N, Buntin MB, Escarce JJ. Does how much and how you pay matter? Evidence from the inpatient rehabilitation care prospective payment system. J Health Econ. 2008 Jul;27(4):1046–59. [PubMed: 18423657]
Anderson MA, Clarke MM, Helms LB, et al. Hospital readmission from home health care before and after prospective payment. J Nurs Scholarsh. 2005;37(1):73–9. [PubMed: 15813590]
Davitt JK, Choi S. The impact of policy on nursing and allied health services. Lessons from the Medicare Home Health Benefit. Res Gerontol Nurs. 2008 Jan;1(1):4–13. [PubMed: 20078013]
Eaton MK. The influence of a change in medicare reimbursement on the effectiveness of stage III or greater decubitus ulcer home health nursing care. Policy Polit Nurs Pract. 2005 Feb;6(1):39–50. [PubMed: 16443958]
FitzGerald JD, Boscardin WJ, Ettner SL. Changes in regional variation of Medicare home health care utilization and service mix for patients undergoing major orthopedic procedures in response to changes in reimbursement policy. Health Serv Res. 2009 Aug;44(4):1232–52. [PMC free article: PMC2739026] [PubMed: 19500167]
FitzGerald JD, Mangione CM, Boscardin J, et al. Impact of changes in Medicare Home Health care reimbursement on month-to-month Home Health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures. Medical Care. 2006:870–8. [PubMed: 16932139]
Lin CJ, Davitt JK, Meit M, et al. The financial impact of interim and prospective payment systems on home health providers in rural communities. J Health Care Poor Underserved. 2005 Aug;16(3):576–87. [PubMed: 16086009]
Lin CJ, Meit M. Changes in Medicare home health care use and practices in rural communities: 1997 to 2001. J Aging Health. 2005 Jun;17(3):351–62. [PubMed: 15857963]
Murtaugh CM, McCall N, Moore S, et al. Trends in Medicare home health care use: 1997-2001. Health Aff (Millwood) 2003 Sep-Oct;22(5):146–56. [PubMed: 14515890]
Schlenker RE, Powell MC, Goodrich GK. Initial home health outcomes under prospective payment. Health Serv Res. 2005 Feb;40(1):177–93. [PMC free article: PMC1361132] [PubMed: 15663708]
Nayar P. The impact of Medicare's Prospective Payment System on staffing of long-term acute care hospitals: the early evidence. Health Care Manage Rev. 2008 Jul-Sep;33(3):264–73. [PubMed: 18580306]
Menke TJ, Ashton CM, Petersen NJ, et al. Impact of an all-inclusive diagnosis-related group payment system on inpatient utilization. Med Care. 1998 Aug;36(8):1126–37. [PubMed: 9708587]
Coburn AF, Fortinsky R, McGuire C, et al. Effect of prospective reimbursement on nursing home costs. Health Services Research. 1993:45–68. [PMC free article: PMC1069921] [PubMed: 8463109]
Ellis R, McGuire T. Hospital response to prospective payment: Moral hazard, selection, and practice-style effects. Journal of Health Economics. 1996;15:257–77. [PubMed: 10159442]
Rosenthal MB. Risk sharing in managed behavioral health care. Health Aff. 1999;18(5):204–13. [PubMed: 10495608]
Rosenthal MB. Risk sharing and the supply of mental health services. Journal of Health Economics. 2000;19:1047–65. [PubMed: 11186844]
Perelman J, Closon MC. Hospital response to prospective financing of in-patient days: the Belgian case. Health Policy. 2007 Dec;84(2-3):200–9. [PubMed: 17624469]
Farrar S, Yi D, Sutton M, et al. Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis. BMJ. 2009;339:b3407. [PMC free article: PMC2733950] [PubMed: 19713233]
Brizioli E, Fraticelli A, Marcobelli A, et al. Hospital payment system based on diagnosis related groups in Italy: Early effects on elderly patients with heart failure. Archives of Gerontology & Geriatrics. 1996:347–55. [PubMed: 15374154]
Hasegawa T, Bragg-Gresham JL, Pisoni RL, et al. Changes in anemia management and hemoglobin levels following revision of a bundling policy to incorporate recombinant human erythropoietin. Kidney Int. 2011 Feb;79(3):340–6. [PubMed: 20962740]
Vos L, Duckers M, Wagner C, et al. Does case-mix based reimbursement stimulate the development of process-oriented care delivery? Health Policy. 2010;98:74–80. [PubMed: 20605051]
Stromberg L, Ohlen G, Svensson O. Prospective payment systems and hip fracture treatment costs. Acta Orthop Scand. 1997 Feb;68(1):6–12. [PubMed: 9057560]
Chen BH, Liu HW, Huang SL, et al. Comparison of appendectomy medical expense and clinical outcome between fee for service and prospective payment system. Kaohsiung J Med Sci. 2000 Jun;16(6):293–8. [PubMed: 11584430]
Tsai YW, Chuang YC, Huang WF, et al. The effect of changing reimbursement policies on quality of in-patient care, from fee-for-service to prospective payment. Int J Qual Health Care. 2005 Oct;17(5):421–6. [PubMed: 15985506]
Wen YP, Wen SY. Do closed-system hospitals shift care under case payment? Early experiences comparing five surgeries in Taiwan. Chang Gung Med J. 2008 Jan-Feb;31(1):91–101. [PubMed: 18419058]
Casale A, Paulus R, Selna M, et al. “ProvenCareSM”: A Provider-Driven Pay-for- Performance Program for Acute Episodic Cardiac Surgical Care. Annals of Surgery. 2007 October;246(4):613–23. 2007. [PubMed: 17893498]
Cromwell J, Dayhoff DA, McCall N, et al. Medicare Participating Heart Bypass Center Demonstration: Final Report. Health Economics Research; Waltham, MA: Jul 24, 1998. 1998.
Abt Associates. Medicare Cataract Surgery Alternate Payment Demonstration: Final Evaluation Report. Cambridge, MA; Bethesda, MD; Chicago, IL: Jun 13, 1997.
Johnson LL, Becker RL. An Alternative Health-Care Reimbursement System—Application of Arthroscopy and Financial Warranty: Results of a 2-Year Pilot Study. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 1994;10(4):462–70. [PubMed: 7945644]
Congressional Budget Office. Budgetary Implications of the Balanced Budget Act of 1997. Congressional Budget Office; Washington, DC: Dec, 1997.
Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. MedPAC; Washington, DC: Mar, 2004.
McCall N, Komisar HL, Peterson A, et al. Medicare home health before and after the BBA. Health Aff. 2001;20(3):189–98. [PubMed: 11585166]
PubReader format: click here to try


  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (1.0M)

Related information

  • PMC
    PubMed Central citations
  • PubMed
    Links to pubmed

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...