Medicare's Bundled Payment initiative: most hospitals are focused on a few high-volume conditions.
The Bundled Payments for Care Improvement initiative is a federally funded innovation model mandated by the Affordable Care Act. It is designed to help transition Medicare away from fee-for-service payments and toward bundling a single payment for an episode of acute care in a hospital and related postacute care in an appropriate setting. While results from the initiative will not be available for several years, current data can help provide critical early insights. However, little is known about the participating organizations and how they are focusing their efforts. We identified participating hospitals and used national Medicare claims data to assess their characteristics and previous spending patterns. These hospitals are mostly large, nonprofit, teaching hospitals in the Northeast, and they have selectively enrolled in the bundled payment initiative covering patient conditions with high clinical volumes. We found no significant differences in episode-based spending between participating and nonparticipating hospitals. Postacute care explains the largest variation in overall episode-based spending, signaling an opportunity to align incentives across providers. However, the focus on a few selected clinical conditions and the high degree of integration that already exists between enrolled hospitals and postacute care providers may limit the generalizability of bundled payment across the Medicare system.
Thomas C. Tsai is a research associate in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a general surgery resident in the Department of Surgery at Brigham and Women's Hospital. He is currently serving as a senior adviser to the deputy assistant secretary for health policy in the Office of the Assistant Secretary for Planning and Evaluation (ASPE), Department of Health and Human Services, in Washington, D.C.
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Karen E. Joynt is currently serving as a senior adviser to the deputy assistant secretary for health policy, ASPE, Department of Health and Human Services. At the time that this article was prepared, she was an instructor of medicine in the Division of Cardiovascular Medicine at Brigham and Women's Hospital and an instructor in the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health.
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Robert C. Wild is a statistical programmer and analyst in the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health.
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E. John Orav is an associate professor of biostatistics at the Harvard T.H. Chan School of Public Health.
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Ashish K. Jha (ajha@hsph.harvard.edu) is the K.T. Li Professor of International Health at the Harvard T.H. Chan School of Public Health, in Boston, Massachusetts.
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D017050:Episode of Care; D018588:Fee-for-Service Plans; D005260:Female; D005102:Health Expenditures; D006282:Health Personnel / Q000458:organization & administration; D006291:Health Policy / Q000331:legislation & jurisprudence*; D017721:Hospital Costs; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D017063:Outcome Assessment, Health Care; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000458:organization & administration; D011050:Policy Making; D014481:United States
Cost of Health Care; Financing Health Care; Health Reform; Health Spending; Hospitals