Unpacking Payment Bundles.

Abstract

Health care consists of 2 predominant drivers: the science behind the services provided to restore, maintain, or improve health; and the economics of paying the rehabilitation professionals and facilities that deliver these essential services. The confluence of science and economics has made the health care delivery system in the United States a complex one, with varied stakeholders and interests. To best manage this system, policy makers deploy strategies and tactics with an aim to get the best health outcome for the dollar spent.1 With many factors impacting the delivery of health care and how health care services are paid, policy makers are in a constant search to align best practice with the right economic incentives. Policy makers use legislation, regulation, and other policies to try to achieve alignment through efforts aimed at managing the benefit via (1) controls on patient access, (2) risk mitigation through cost-containment strategies for the payer, or (3) penalties and incentives to drive the rehabilitation professional's behavior and practice. The growth in health care spending in the past couple of decades has led to a growing need to reorganize the system to reduce cost, increase access, improve care coordination, and improve quality—and ultimately has led to reforms to shift costs to patients, manage payment through cost containment, or redesign care delivery. Bundling is a policy strategy that combines cost containment with delivery system reforms centered on care coordination and patient outcomes. Bundled payments are the consolidation of payment for a continuum of health care services for a defined population with a specified diagnosis or clinical condition for a specific episode of care.2 Bundled payment methodologies aim to strike a balance between fee-for-service and capitated payment models. They also seek to reduce the incentives of fee-for-service models when fragmented care has the potential to drive …