Will Bundled Payments Change Health Care? Examining the Evidence Thus Far in Cardiovascular Care.

Abstract

Episode-based, “bundled” payments have come to the forefront of the national discussion on combating rising healthcare costs. In the currently dominant fee-for-service model for reimbursement, hospitals, physicians, and postacute care providers file distinct claims and are paid separately for provided services even when they are related to a single episode of care. However, this approach to payment encourages fragmented care, with little incentive for resource stewardship, coordination, or communication across multiple providers. In contrast, bundled payments seek to align the interests of providers by providing a fixed payment for all services given during a single episode of care. This payment is distributed among all providers in a healthcare system involved with that patient, including hospitals and other facilities. Although not a new policy initiative, bundled payments have resurfaced in the current era of healthcare reform, with its advocates arguing that it can curtail healthcare costs while simultaneously improving quality. Cardiovascular care is the arena in which implementation of bundled payments is arguably most visible and may be most impactful. Many previous demonstrations of bundled payments have concentrated on cardiovascular conditions, and it is likely that future efforts will continue to do so, with good reason. First, cardiovascular diseases are common, costly, and deadly1 and therefore are important in national discussions for healthcare reform. Second, care for cardiovascular disease involves multiple providers from different disciplines (primary care, cardiology, cardiac surgery, anesthesiology, radiology). Lastly, cardiovascular patients receive care in multiple healthcare settings (hospital, outpatient primary care and subspecialty clinics, skilled nursing facility, etc). Given all these factors, bundled payments have the potential to substantially improve care coordination and to generate savings for cardiovascular care. In the present article, we further explore bundled payment initiatives and their potential advantages and disadvantages, focusing our review on previous and current bundled payment programs for …