Developing a Playbook for IPU-based Surgical Care and New Payment Models

NEJM July 17, 2019
Frank Opelka

Conventional wisdom is that doctors — and especially surgeons — do not want to bundle health care. Under the right circumstances in support of surgical excellence, the American College of Surgeons (ACS) supports team-based care and alternative payment systems that appropriately measure quality and value and assign bundled payments.

For more than half a century, surgeons have operated by implementing the principles of team-based care in surgical disciplines such as trauma care or cancer care. Yet, payment remains in silos, purchasing clinical services using fee-for-service payment from each of the team member’s contributions along the care continuum. Fee-for-service seems rational when care models are very limited in time and scope and only a few clinical services apply to the care...

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