-
The Milbank Quarterly Sep 2020Policy Points Evidence suggests that bundled payment contracting can slow the growth of payer costs relative to fee-for-service contracting, although bundled payment...
UNLABELLED
Policy Points Evidence suggests that bundled payment contracting can slow the growth of payer costs relative to fee-for-service contracting, although bundled payment models may not reduce absolute costs. Bundled payments may be more effective than fee-for-service payments in containing costs for certain medical conditions. For the most part, Medicare's bundled payment initiatives have not been associated with a worsening of quality in terms of readmissions, emergency department use, and mortality. Some evidence suggests a worsening of other quality measures for certain medical conditions. Bundled payment contracting involves trade-offs: Expanding a bundle's scope and duration may better contain costs, but a more comprehensive bundle may be less attractive to providers, reducing their willingness to accept it as an alternative to fee-for-service payment.
CONTEXT
Bundled payments have been promoted as an alternative to fee-for-service payments that can mitigate the incentives for service volume under the fee-for-service model. As Medicare has gained experience with bundled payments, it has widened their scope and increased their duration. However, there have been few reviews of the empirical literature on the impact of Medicare's bundled payment programs on cost, resource use, utilization, and quality.
METHODS
We examined the history and features of 16 of Medicare's bundled payment programs involving hospital-initiated episodes of care and conducted a literature review of articles about those programs. Database and additional searches yielded 1,479 articles. We evaluate the studies' methodological quality and summarize the quantitative findings about Medicare expenditures and quality of care from 37 studies that used higher-quality research designs.
FINDINGS
Medicare's bundled payment initiatives have varied in their design features, such as episode scope and duration. Many initiatives were associated with little to no reduction in Medicare expenditures, unless large pricing discounts for providers were negotiated in advance. Initiatives that included post-acute care services were associated with lower expenditures for certain conditions. Hospitals may have been able to reduce internal production costs with help from physicians via gainsharing. Most initiatives were not associated with significant changes in quality of care, as measured by readmission and mortality rates. Of the significant changes in readmission rates, the results were mixed, showing increases and decreases associated with bundled payments. Some evidence suggested that worse patient outcomes were associated bundled payments, although most results were not statistically significant. Results on case-mix selection were mixed: Several initiatives were associated with reductions in episode severity, whereas others were associated with little change.
CONCLUSIONS
Bundled payments for hospital-initiated episodes may be a good alternative to fee-for-service payments. Bundled payments can help slow the growth of payer spending, although they do not necessarily reduce absolute spending. They are associated with lower provider production costs, and there is no overwhelming evidence of compromised quality. However, designing a bundled payment contract that is attractive to both providers and payers proves to be a challenge.
Topics: Cost Savings; Hospital Costs; Hospitalization; Humans; Length of Stay; Medicare; Patient Care Bundles; Reimbursement Mechanisms; United States
PubMed: 32820837
DOI: 10.1111/1468-0009.12465 -
Journal of Hospital Medicine Mar 2015Outpatient versus inpatient status determinations for hospitalized patients impact how hospitals bill Medicare for hospital services. Medicare policies related to status... (Comparative Study)
Comparative Study Review
Outpatient versus inpatient status determinations for hospitalized patients impact how hospitals bill Medicare for hospital services. Medicare policies related to status determinations and the Recovery Audit Contractor (RAC) program charged with postpayment review of such determinations are of increasing concern to hospitals and physicians. We present an overview and discussion of these policies, including the recent 2-midnight rule, the effect on status determinations by the RAC program, and other recent and pertinent legislative and regulatory activity. Finally, we discuss the future direction of Medicare status determination policies and the RAC program, so that physicians and other healthcare providers caring for hospitalized Medicare beneficiaries may better understand these important and dynamic topics.
Topics: Hospitalization; Humans; Inpatients; Medicare; Outpatients; Time Factors; United States
PubMed: 25557865
DOI: 10.1002/jhm.2312 -
Health Care Financing ReviewThis year marks the 40th anniversary of the Medicare Program. Medicare has achieved its two basic goals of ensuring access to care for elderly and disabled beneficiaries...
This year marks the 40th anniversary of the Medicare Program. Medicare has achieved its two basic goals of ensuring access to care for elderly and disabled beneficiaries and protecting them from severe financial hardship. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 represents an important improvement by adding prescription drug coverage. Medicare's major future challenge is responding to the retirement of the baby boom generation and rising health care costs. Promising policy options should aim to ensure health and financial security for beneficiaries and proactively use Medicare's purchasing power to achieve greater efficiency and quality in health care for Medicare beneficiaries and all Americans. More policy attention needs to be focused on debating Medicare's future, a more complex issue than even Social Security.
Topics: Adult; Aged; Consumer Behavior; Health Services Accessibility; History, 20th Century; Humans; Insurance, Pharmaceutical Services; Medicare; Middle Aged; United States
PubMed: 17290637
DOI: No ID Found -
JAMA Sep 2023
Topics: Aged; Humans; Medicare; United States; Therapies, Investigational
PubMed: 37682556
DOI: 10.1001/jama.2023.15814 -
Journal of the American Board of Family... 2006A major challenge for the US health care system during coming years will be the financial viability and reorganization of Medicare--a program in which over 90% of family... (Review)
Review
A major challenge for the US health care system during coming years will be the financial viability and reorganization of Medicare--a program in which over 90% of family physicians participate. Although chronic illness constitutes a trajectory characterized by long-term patterns of health and functional states, fee-for-service Medicare is largely directed to the treatment of acute, episodic illness. Beyond the prescription drug benefit, there were several provisions in the Medicare Prescription Drug Improvement and Modernization Act of 2003 that were designed to improve the quality of care and reduce costs for chronically ill beneficiaries, an important first step in the reorientation of Medicare to chronic illness care. Quality is the foundation of Medicare's movement to a chronic care program and paying physicians for quality care is on the horizon. Family physicians will need to be actively engaged in Medicare's reorientation by articulating and promoting a quality of care that effectively integrates evidence-based medicine with a person-centered focus.
Topics: Aged; Chronic Disease; Humans; Insurance, Pharmaceutical Services; Medicare; Quality of Health Care
PubMed: 16672683
DOI: 10.3122/jabfm.19.3.303 -
Journal of Health Politics, Policy and... Apr 2007
Topics: Aged; Health Care Reform; Humans; Medicare; Politics; United States
PubMed: 17463409
DOI: 10.1215/03616878-2006-040 -
Hospital Topics Aug 1965
Topics: Geriatrics; Health; Humans; Insurance; Insurance, Health; Medicare; United States
PubMed: 14345614
DOI: 10.1080/00185868.1965.9955188 -
Ophthalmology Jan 2017
Topics: Health Expenditures; Humans; Medicare; Organizational Policy; Physicians; Prospective Payment System; United States
PubMed: 27993265
DOI: 10.1016/j.ophtha.2016.11.006 -
The New England Journal of Medicine Jul 2023
Topics: Aged; Humans; Drugs, Generic; Medicare; Negotiating; United States; Commerce; Drug Costs
PubMed: 37428191
DOI: 10.1056/NEJMp2304289 -
JACC. Heart Failure Jun 2024
Topics: Humans; Heart Failure; United States; Medicare; Disease Management
PubMed: 38839149
DOI: 10.1016/j.jchf.2024.02.029