PQRI, VBP, ACO, eRx, MoC ...: understanding the lexicon of health-care-reform legislation.

摘要

The perfect storm Health-care expenditures have been rising at an alarming rate. Compared with annualized 0.5-5% increases evident in the 1990s, the most recent estimates approximate a 9.3% increase per annum (1). Health-care costs, as a percentage of the gross domestic product (GDP), increased from 13.1% in 1990 to 14.9% in 2002 and 17.9% in 2009 (2). Since 2001, health insurance premiums are up 59%, albeit the percentage of workers covered has fallen from 65% to 61% (3). The most recent estimate from the Medicare trustees predicts that, given the continued escalation of expenditures, the Medicare fund will be bankrupt by 2024-five years earlier than they predicted in 2010 (4)! Clearly, the current health-care financial model is not sustainable. Accordingly, much attention (and legislation) has been focused on health-care reform. Physicians, however, for the most part concentrating on issues related to patient care, have been fairly naive in their understanding of the implications of all the legislated mandates. This discussion provides an overview to alert care providers to legislative mandates (and confusing lexicons) and to highly specific implications relevant to gastroenterology clinical practice.