Rehab Select Blog

The bundled payment model is a value-based model that compensates healthcare providers for specified episodes of care via an agreed-upon flat rate. A departure from the traditional fee-for-service payment model, bundled payments are designed to reduce healthcare costs and improve quality of care by creating incentives for the establishment of more streamlined and well-coordinated care pathways.

The bundled payment model is becoming ever more popular in healthcare, with a growing number of government payers – Medicare, for instance – larger healthcare systems, employers, insurers, and other payers rolling out these plans as an alternative to the traditional fee-for-service model. This trend towards a value-based payment model has become even more pronounced over the past few years with the implementation of the Affordable Healthcare Act. Much of the discussion about the merits of bundled payments has centered upon the benefits they can yield for healthcare providers and payers, but these plans offer significant benefits to healthcare consumers as well. So just how do bundled payments help patients?

Bundled care payment models can be very beneficial to your practice and your patients, provided your venture into these arrangements is well thought out and efficiently managed. Perhaps the most important thing to know as you prepare to align with this relatively new value-based payment model is that you'll need strong leadership and solid strategies to meet the cost control and quality benchmarks that are built into bundled payment plans. Among the most important points to consider as you strive to make the most of the bundled payment model, consider the following. 

Bundled payment arrangements are becoming increasingly common in heathcare today, offered by a wide variety of private health insurance companies, healthcare systems, and other healthcare stakeholders as well as Medicare and other government healthcare programs. While bundled payment is, with the advent of the Affordable Care Act, mandatory under some circumstances, for most providers these arrangements are still optional. If you're on the fence about these plans, here are 3 important reasons why participation in bundled payment programs may just make sense for your practice.

The bundled payment initiative for joint replacement surgeries was set to begin on April 1, 2016. This initiative, finalized by the Centers for Medicare & Medicaid Services (CMS) in November, 2015, is known as the Comprehensive Care for Joint Replacement (CJR) model and will affect, as of its start date, approximately 800 hospitals that deliver care to Medicare fee-for-service beneficiaries for hip and knee replacements and/or other major leg procedures. Here we'll get into the basic details that patients and caregivers will need to know about this initiative.

Bundled payments are on the rise as an alternative to the traditional fee-for-service model. This payment method will affect the practices of most medical professionals at some point in the near future – if they haven't already – especially in episodes of care that involve conditions with low-cost variability or procedures with reliable outcomes (joint replacement surgery, for instance). This type of reimbursement can be an opportunity for practices that manage the process well – for both practice and patients – and a loser for those who don't. 

2010 marked the passing of the Affordable Care Act, which was intended to overhaul the existing U.S. healthcare system. Its central goal was to provide higher quality and more efficient healthcare at decreased costs, made available to expanded numbers of people.

As an extension of the act, the Bundled Payments for Care Improvement (BPCI) initiative was rolled out in 2011. The BPCI initiative speaks directly to the mission of the Affordable Care Act, centrally in its incentive-driven method of improving quality of care and implementing an efficient process of distributing payment to healthcare facilities.