Analysis: Mandatory bundled payments have few advantages over voluntary bundles

Hospitals in voluntary and mandatory bundle payment models vary by size and volume, but quality and ability to curb spending is largely the same, according to a new study.

Those findings might cool the flames of a yearslong debate over the impact of mandatory versus voluntary payment models.

Research published in the June issue of Health Affairs found that hospitals in the voluntary Bundled Payments for Care Improvement model were typically larger and had a higher mean patient volume compared to hospitals in the mandatory Comprehensive Care for Joint Replacement model.

Smaller, financially struggling hospitals are more likely to pass on a voluntary model due difficultly handling the additional administrative burden, which larger hospitals can more easily absorb.

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While there were large differences in the characteristics of program participants, there were smaller discrepancies in quality or spending. Voluntary programs, for instance, spend slightly more on postacute care. Mandatory programs produced more generalized evidence compared to voluntary programs, the study found.

The findings might calm the debate about which approach is more effective in transitioning the industry to value-based care.

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The Trump administration has pulled back mandatory bundles in the past year, saying they hurt low-admission hospitals, while researchers have said that voluntary models don't produce sound data.

"These findings could temper policy makers’ expectations that either voluntary or mandatory programs alone can achieve the desired broad impact," the study's authors said. "Instead, our results suggest that both voluntary and mandatory approaches can play an important role in engaging hospitals across the country, and that perhaps policy makers should not restrict policy options to one approach over the other."