Public interest rising in bundled payments, but uncertainties remain

When a term appears in USA Today, you can be pretty sure it has gone mainstream--and this week, the term "bundled payments' is featured in a piece in the national daily, suggesting that if nothing else, the idea is getting more mindshare than ever before. With a Medicare bundled payment pilot in place, and discussion of using this mechanism more widely in health reform bills on the Hill, the public was inevitably going to begin discussing the idea.

At the moment, however, nobody seems to be all that clear how widely the concept should be implemented, USA Today notes. Medicare is far from proving that the bundled payment approach works to both save money and improve quality, as supporters say it can. 

With the three-year experiment only in its first few months of life (it began in May) there's been too little time to collect persuasive data. Meanwhile, early private sector experiments--such as one put in place at Geisinger Healthcare--are still too scattered to provide any clear direction as to whether bundles are a good idea.

While Medicare is getting lower rates on a few packages, such as the 4.4 percent discount the program negotiated on heart and joint surgery packages at Tulsa's Hillcrest Medical Center, Hillcrest is already considered to be a high-quality, cost-effective provider. The same is true of Baptist Health System in San Antonio, another participant, as well as Denver, Albuquerque and Oklahoma City hospitals that will begin participating before the end of the year.

Add the fact that Medicare is paying patients who use the hospitals for most heart and orthopedic procedures a bonus of up to $1,157, and it's really hard to tell who's motivated by what. The truth is, in this case, it seems that the public dialog may actually be well ahead of the research.

To learn more about this trend:
- read this USA Today piece

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