Bundled Payment Project
There is growing interest in the health care industry and health policy world in the concept of paying for medical treatment on the basis of the "episode of care" rather than the individual test, procedure, or visit (fee-for-service) or the population-based continuum of care (capitation). Establishing a single budget or fee for care that involves multiple providers (and provider types) may redress quality and efficiency problems that are rewarded by current payment systems, which increase reimbursement with increased volumes of services. Pricing mechanisms that bundle and fix the price of the components of a complex episode of care also represent a critical first step in providing consumers with transparent price and quality metrics, tools needed to make an informed, value-based selection of a provider team.
The potential of episode payment to achieve both quality and cost improvements was initially shown in the early 1990s by Medicare's Coronary Artery Bypass Graft Demonstration project. During its five-year run, this demonstration saved Medicare $42 million on coronary bypass patients treated in the demonstration hospitals, an average discount of roughly 10% from expected spending, including a 90-day post-discharge period.
Presentations by BCHT Director James Robinson on the topic of "bundled episode payment" include:
A Framework for Payment Reform
IHA National Pay for Performance Summit; March 11, 2010
Bundled Payment for Orthopedic Surgery and Other High-Cost Device-Intensive Services
University of Texas Health System; February 17, 2010
