Bundled Payments

A payment mechanism that reimburses health care providers for the expected cost of a specific episode of illness, rather than for each service delivered. 

Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes

Jun. 29, 2017

Laura A. Dummit, Daver Kahvecioglu, Grecia Marrufo, Rahul Rajkumar, Jaclyn Marshall, Eleonora Tan, Matthew J. Press, Shannon Flood, L. Daniel Muldoon, Qian Gu, Andrea Hassol, David M. Bott, Amy Bassano, Patrick H. Conway

In JAMA, Laura Dummit and colleagues, including Matthew Press, evaluate whether a Centers for Medicare and Medicaid Services (CMS) bundled payment pilot program is associated with a reduction in Medicare payments. Specifically, the authors assess if Bundled Payments for Care Improvement (BPCI) reduced Medicare payments and maintained quality in lower extremity joint replacement. This CMS program was launched in 2013 to test whether linking payments for services provided during an episode of care can reduce Medicare payments and maintain quality. The authors used a difference-in-...

Effects of the ACA on Health Care Cost Containment

Issue Brief
Mar. 2, 2017

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

New Study Details Savings from Bundled Payments

Jan. 13, 2017

This is the way it is supposed to work. You develop policy and processes to drive innovation. You design and test innovative ideas in a small, efficient way. You learn and adapt. Successful innovation drives new policy. Rinse and repeat.

And this is the way it appears to have worked, in the case of Medicare bundled payment. Start small with a pilot. Expand in reach and scope if promising. Scale up if successful.

Cost of Joint Replacement Using Bundled Payment Models

Research Brief
Amol Navathe, MD, PhD
Jan. 6, 2017

Evidence on the effects of bundled payment is more important than ever, while hospitals already in Medicare bundled payment programs need guidance in redesigning care. This observational study looks at whether bundled payment for joint replacement affected quality, hospital costs and post-acute care spending in a health system that was an early adopter of the model. Did the bundles save money, and if so, what produced those savings?

Health Systems and Social Determinants

Dec. 1, 2016

The election of Donald Trump has ushered in an uncertain future for the Affordable Care Act (ACA), from modification to total repeal. While many policy experts are concerned about people losing the coverage they gained through the ACA, other aspects of the ACA are also under threat: specifically, provisions that address the social determinants of health.

Outsmarting Risk: Winning Strategies for Bundled Payment

Jul. 19, 2016
There is a four-letter word that is used a lot in health care, and that’s risk. With the goal of making health care more affordable, financial risk is being redistributed among payers, providers and patients, with a particular focus on shifting the risk onto providers to change the way they deliver care. More Risks for Hospitals In 2011, under the Affordable Care Act, the Center for Medicare and Medicaid Services (CMS) launched the Bundled Payments for Care Improvement (BPCI) initiatives to test whether bundled payment can reduce cost while maintaining or improving the quality of care for...

Physician Referrals, Delivery System Reform, and The Diffusion of Information

Jan, 2015
Principal Investigator:
Lawton R. Burns, PhD, MBA

Abstract: Physician-to-physician referrals play a central role in the health care systems and are drives of costs and quality. There is evidence that referrals are currently misused and overused and recognition that they will have to change if health reform objectives such as care coordination and cost reduction are to be achieved (Son et al., 2014). Indeed, many of the models of care supported by the Affordable Care Act (e.g., accountable care organizations (ACOs), patient-centered medical homes, bundled payments) depend on physicians making high-value referrals.

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