Although surgical bundles have yielded promising results for Medicare, bundling medical conditions hasn't delivered the same success, HealthAffairs reports.
Here's what you should know:
1. Surgical joint replacement bundles are linked to a 3.8 percent decrease in per-episode spending, as well as equal or better quality, according to an evaluation of the Medicare Bundled Payments for Care Improvement initiative. Other studies show bundled models may reduce joint replacement episode costs by 20-plus percent and cause slight quality improvements.
2. However, for medical conditions such as congestive heart failure and chronic obstructive pulmonary disease, bundles aren't associated with significant changes in quality or Medicare spending.
3. Results between the two bundle types may differ because Medicare has targeted reductions in post-acute utilization and spending as ways to cut costs. This approach is better suited for surgical care than medical care, according to HealthAffairs.
4. Physicians and hospitals have differing capabilities with regard to impacting post-acute care utilization and spending.
5. Medical bundles tend to involve patients who are older and at higher risk for poverty and disability than joint replacement patients, which also makes shifting discharges away from post-acute care providers challenging under this model.
6. Although medical bundles may not currently improve the value of care, policymakers should work to improve the design of these alternative payments by modifying when and how episodes begin and designing more restrictions on post-discharge care.