Abstract
A bundled payment model is a method of reimbursement in which a single, comprehensive payment is made for a solitary episode of care. Multiple models for bundling services and payments have been developed across a wide variety of surgical services, including coronary bypasses and joint replacements. In 2011, the Centers for Medicaid and Medicare Services (CMS) proposed the Bundled Payments for Care Improvement Initiative (BPCI) to stimulate development of new prospective payment strategies. This proposal was presented with the anticipation of uniting hospitals and providers to focus on coordinated patient management and no longer emphasize payment based solely on volume of care. Four separate bundled payment models were proposed and have been slowly introduced into practice over the past several years. Private entities and regional/state-level healthcare insurers are also developing similar bundling models based on lessons learned from the CMS experience. The four main concerns of bundled payment plan creation include the identification of trigger episodes, determination of cost, establishment of gain sharing, and limiting exposure to risk through adjustment. Bariatric surgery is a procedure that is amenable to bundled payment creation due to its relatively low complication rate and protocol-driven care. Bariatric surgeons should be familiar with the components and the language of bundled payment construction plans so that they might be more approachable as a resource during their development. Bariatric surgeons should advocate for protecting the access to care interests of their patients in addition to limiting the financial risks to providers and their affiliated healthcare facilities.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Neu CR, Palmer A, Henry DP, Olson GT, Harison S. Extending the medicare prospective payment system to posthospital care: planning a demonstration. Santa Monica: RAND Corporation; 1986.
Johnson LL, Becker RL. An alternative health-care reimbursement system-application of arthroscopy and financial warranty: results of a 2-year pilot study. Arthroscopy. 1994;10(4):462–70.
Cromwell J, Dayhoff DA, Thoumaian AH. Cost savings and physician responses to global bundled payments for medicare heart bypass surgery. Heath Care Financ Rev. 1997;19(1):41–57.
Miller J. Package pricing: Geisinger’s new model holds the promise of aligning payment with optimal care. 2008 June. Available from: http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/content/package-pricing-geisingers-new-model-holds-promise-aligning-pay?page=full.
Kivlahan C, Orlowski JM, Pearce J, Walradt J, Baker M, Kirch DG. Taking risk: early results from teaching hospitals’ participation in the center for medicare and medicaid innovation bundled payments for care improvement initiative. Acad Med. 2016;91(7):936–42.
United States. CMS bundled payment fact sheet. 2016. Available from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-18.html.
Dummit L. CMS bundled payment payments for care improved initiative models 2–4: year 3 evaluation & monitoring annual report. Fall’s Church: Lewin Group (US); 2017. Available from: https://downloads.cms.gov/files/cmmi/bpci-models2-4yr3evalrpt.pdf.
Whitcomb WF, Lagu T, Krushell RJ, Lehman AP, et al. Experience with designing and implementing a bundled payment program for total hip replacement. Jt Comm J Qual Patient Saf. 2015;41(9):406–13.
Birkmeyer JD, Gust C, Baser O, Dimick JB, Sutherland JM, Skinner JS. Medicare payments for common inpatient procedures: implications for episode-based payment bundling. Health Serv Res. 2010;45(6 Pt 1):1783–95.
Althausen PL, Mead L. bundled payments for care improvement: lessons learned in the first year. J Orthop Trauma. 2016;30(Suppl 5):S50–S53.e.
Navathe AS, Troxel AB, Liao JM, Nan M, Zhu J, Zhong W, Emanuel EJ. Cost of joint replacement using bundled payment models. JAMA Intern Med. 2017;177(2):214–22.
Courney PM, Ashley BS, Hume EL, Kamath AF. Are bundled payments a viable reimbursement model for revision total joint arthroplasty? Clin Orthop Relat Res. 2016;474(12):2714–21.
Doran JP, Beyer AH, Bosco J, Naas PL, Parsley BS, Slover J, Zabinski SJ, Zuckerman JD, Iorio R. Implementation of bundled payment initiatives for total joint arthroplasty: decreasing cost and increasing quality. Instr Course Lect. 2016;65:555–66.
Iorio R, Clair AJ, Inneh IA, Slover JD, Bosco JA, Zuckerman JD. Early results of medicare’s bundled payment initiative for a 90-day total joint arthroplasty episode of care. J Arthroplast. 2016;31(2):343–50.
Chen LM, Meara E, Birkmeyer JD. Medicare’s bundled payments for care improvement initiative: expanding enrollment suggests potential for large impact. Am J Manag Care. 2015;21(11):814–20.
Suggested Resources
Althausen PL, Mead L. Bundled payments for care improvement: lessons learned in the first year. J Orthop Trauma. 2016;30(Suppl 5):S50–3.
Center for Healthcare Quality and Payment Reform. http://www.chqpr.org/ http://www.chqpr.org/downloads/ImprovingResourceUseMeasurementUnderMACRA.pdf.
CMS Active BPCI Models. https://innovation.cms.gov/initiatives/map/index.html#model=.
CMS Bundled Payment Learning and Resource Center. https://innovation.cms.gov/initiatives/Bundled-Payments/learning-area.html.
Dundon JM, Bosco J, Slover J, Yu S, Sayeed Y, Iorio R. Improvement in total joint replacement quality metrics: year one versus year three of the bundled payments for care improvement initiative. J Bone Joint Surg Am. 2016;(23):1949–53.
Greenwald AS, Bassano A, Wiggins S, Froimson MI. Alternative reimbursement models: bundle payment and beyond: AOA critical issues. J Bone Joint Surg Am. 2016;98(11):210–6.
Grenda TR, Pradarelli JC, Thumma JR, Dimick JB. Variation in hospital episode costs with bariatric surgery. JAMA Surg. 2015;150(12):1109–15.
Murphy SB, Bolz NJ, Terry DP, Talmo CT, Fehm MN. The physician as the provider at risk: rolling the dice. J Arthroplast. 2016;31(5):938–44.
Newhall K, Stone D, Svoboda R, Goodney P. Possible consequences of regionally based bundled payments for diabetic amputations for safety net hospitals in Texas. J Vasc Surg. 2016;64(6):1756–62.
Scally CP, Thumma JR, Birkmeyer JD, Dimick JB. Impact of surgical quality improvement on payments in medicare patients. Ann Surg. 2015;262(2):249–52.
Scally CP, Shih T, Thumma JR, Dimick JB. Impact of a national bariatric surgery center of excellence program on medicare expenditures. J Gastrointest Surg. 2016;20(4):708–14.
Slover JD. You want a successful bundle: what about post-discharge care? J Arthroplast. 2016;31(5):936–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Northup, C.J., Scott, J.D. (2019). Bundled Payments for Bariatric Surgery. In: Morton, J., Brethauer, S., DeMaria, E., Kahan, S., Hutter, M. (eds) Quality in Obesity Treatment. Springer, Cham. https://doi.org/10.1007/978-3-030-25173-4_19
Download citation
DOI: https://doi.org/10.1007/978-3-030-25173-4_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-25172-7
Online ISBN: 978-3-030-25173-4
eBook Packages: MedicineMedicine (R0)