Bundled Payments for Surgical Care-More Questions Than Answers

Bundled payment models assign financial responsibility for extended episodes of care up to 90 days after operation. The report by Koeckert et al, in this issue, describes 376 patients having either transcatheter aortic valve replacements or surgical aortic valve replacements. They investigated the impact of readmissions on the Bundled Payments for Care Improvement initiative (BPCI) payment for Medicare valve patients. The authors' hospital was designated as a BPCI institution that linked reimbursement to the different phases of care (in-patient, outpatient follow-up, emergency visits, and other postacute care) up to 90 days after operation. They found that bundled costs were significantly increased above BPCI reimbursements in readmitted patients, especially transcatheter aortic valve replacements patients who were readmitted late up to 90 days after operation. This apparent disconnect between BPCI reimbursement and actual costs raises questions about BPCI reimbursement.