Bundled payment and enhanced recovery after surgery

Area of Science:

• Healthcare economics
• Health policy
• Medical payment reform

Background:

• The current Medicare fee-for-service (FFS) payment model faces challenges with unsustainable spending growth.
• Alternative payment models are being explored to address FFS limitations and improve healthcare value.
• Bundled payment represents a leading alternative to traditional FFS for managing costs and quality.

Purpose of the Study:

• To examine the Centers for Medicare & Medicaid Services' (CMS) initiatives in healthcare payment reform.
• To highlight the development and scope of bundled payment models within Medicare.
• To identify the inclusion of surgical care within new bundled payment episodes.

Main Methods:

• Analysis of CMS's Center for Medicare and Medicaid Innovation's bundled payment models.
• Review of the 48 discrete clinical condition episodes developed under these models.
• Identification of surgical care procedures within the defined episodes.

Main Results:

• CMS has introduced four distinct bundled payment models.
• These models encompass 48 specific clinical condition episodes.
• A significant number of surgical care procedures are integrated into these bundled payment episodes.

Conclusions:

• Bundled payment models are a key strategy for Medicare to enhance healthcare quality and reduce costs.
• The expansion of bundled payments, particularly for surgical care, signifies a shift from traditional fee-for-service.
• These initiatives aim to create more value-based care pathways within the Medicare program.