Bundled Payment Programs

Las Vegas—From the mid-1990s to the early 2000s, bundled payment programs were popular in certain areas of the United States. In most cases, though, they failed because administration of the programs was difficult and they were only focused on financial rewards, according to Neil M. Pressman, FACHE, partner at Prescott Associates.

After the introduction of the Patient Protection and Affordable Care Act in March 2010, bundled payments were re-introduced. They are 1 of several initiatives that are hoping to make a smooth transition from fee-for-service to paying for quality of care and cost savings, which has been difficult in the past.

“Hopefully we’ll make it work this time,” said Dr. Pressman, who spoke at the Fall Managed Care Forum during a session titled Bundled Payment Programs: Strategic and Tactical Planning.

The Centers for Medicare & Medicaid Services has several bundled payments programs, according to Dr. Pressman, including the acute care episode demonstration, the bundled payment for care improvement initiative, and the national pilot program. In each program, providers are paid a fee for each, and they define value as the quality of care, cost management and reduction, and coordinated care and care management. Dr. Pressman said the following conditions are appropriate for bundled payments: joint replacement, obstetrics, bariatric surgery, coronary artery bypass graft, valve replacement, and neurosurgery.—Tim Casey