Please see information on the Hysterectomy Report under the “Reproductive Health” section.
Surgery Bundles and Payment Models
Bariatric Surgery Bundle and Warranty
Guideline title: Bariatric Surgery Bundle and Warranty Report and Guidelines
Publication Status: Needs minor revisions – to be scheduled
Date of publication: 2016
Date of last evidence search: 2016
Scope: Diagnosis, assessment for surgery fitness, procedure, post operative care
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the intent of the warranty is to distribute financial risk across professional and facility components in proportion to the revenue generated by the procedure. Our bundled payment model includes bariatric surgery as a treatment option for select individuals and requires a holistic approach in which surgery is but one possible component of care. We organize our bundled payment model into four cycles including: appropriateness outlining requirements for a trial of non-surgical care, requirements for fitness for surgery, elements of best practice surgery and components of care aimed at our ultimate outcome, rapid return to function.
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
Cardiovascular Health
Guideline title: Cardiovascular Health – Appropriateness of Percutaneous Coronary Interventions Report and Guidelines
Publication Status: Needs minor revisions – to be scheduled
Date of publication: 2013
Date of last evidence search: 2013
Scope: clinical scenarios and indications
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the warranty includes no reimbursement for complications resulting from poor care. Percutaneous coronary intervention (PCI), also known as angioplasty, is a non-surgical procedure used to treat excess plaque in the arteries. While the majority of these procedures are done appropriately and successfully as needed for emergency cardiovascular conditions, a significant number are done electively and may not benefit patients in the same way. One way to improve care given to patients is to look at the data on whether past PCI procedures were appropriate. The availability and transparency of this data is a major issue across Washington State hospitals.
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
Coronary Artery Bypass Graft Surgery Bundle and Warranty
Guideline title: Coronary Artery Bypass Graft (CABG) Surgery Bundle and Warranty Report and Guidelines
Publication Status: Needs minor revisions – to be scheduled
Date of publication: 2015
Date of last evidence search: 2015
Scope: Diagnosis, assessment for surgery fitness, procedure, post operative care
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the intent of this warranty is to distribute financial risk across professional and facility components in proportion to the revenue generated by the procedure. We believe the CABG bundle represents an incremental advance in helping to create a market for quality in health care. We will continue to refine and improve the bundle as new information becomes available. We encourage purchasers to contribute to the success of this bundle by reimbursing for essential services (e.g., health coach, care coordination)
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
Lumbar Fusion Surgical Bundle and Warranty
Guideline title: Lumbar Fusion Surgical Bundle and Warranty Report and Guidelines
Publication Status: Needs minor revisions – to be scheduled
Date of publication: 2018
Date of last evidence search: 2018
Scope: Diagnosis, assessment for surgery fitness, procedure, post operative care
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the warranty* is against avoidable hospital readmissions. We selected lumbar fusion due to a disproportionate rise in lumbar fusion compared to other spine surgeries, high variation in quality and billed charges, and evidence that for many patients considered candidates for elective lumbar fusion, there was no clear benefit of surgery compared to non-surgical care.
- Quality standards: appropriateness, evidence-based surgery, ensuring rapid and durable return to function, the patient care experience, and avoidance of readmissions as an indicator of safety and control of cost.
- *Warranty: purchaser will not provide reimbursement for readmission for avoidable complications within the risk windows specified at 7, 30, and 90 days.
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
Total Knee and Total Hip Replacement Surgical Bundle and Warranty
Guideline title: Total Knee and Total Hip Surgical Bundle and Warranty Report and Guidelines
Publication Status: Active
Date of publication: 2021
Date of last evidence search: 2021
Scope: Diagnosis, assessment for surgery fitness, procedure, post operative care
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the warranty includes no reimbursement for complications resulting from poor care. We selected total knee and total hip replacement bundle and warranty which is primarily designed for osteoarthritis, but these standards may be applied to joint replacement related to other conditions.
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
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