AHA Research Synthesis Report: Bundled Payment

- March 01, 2010

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Bundled Payment: An AHA Research Synthesis Report presents an overview of bundled payment, including evidence of its impact in the public and private sector, as well as questions that must be considered as the concept is carried forward by both policymakers and delivery organizations.

The report defines bundled payment and explains its place in the current environment of health reform, including the stipulation in the reform law for the establishment of a National Pilot Program on Payment Bundling for the Medicare program by 2013 and a Medicaid bundling demonstration program by 2012.

The discussion of the evidence surrounding bundled payment begins with a chart that introduces eight selected bundled payment demonstrations that have been mounted from 1987 until today. The study of these eight examples illustrates the following main points:

1. Bundled payment could potentially reduce spending on an episode of care.
2. Providers' readiness to participate in bundled payment programs varies.
3. Bundled payments can spur quality improvement.

The eight examples of bundled payment however reveal gaps in the knowledgebase of how bundled payment should be structured. Each of the questions are provided with expanded detail:

1. To which conditions should bundled payments be applied?
2. What providers and services should be included in the bundled payment?
3. How can provider accountability be determined?
4. What should be the timeframe of a bundled payment?
5. What capabilities are needed for organizations to administer a bundled payment?
6. How should payments be set?
7. How should the bundled payment be risk-adjusted?
8. What data are needed to support bundled payment?

The report concludes with a summary of key references on bundled payment, including federal and private sector proposals, evaluations, evaluations of demonstration projects and other key pieces of literature about the issue.

Bundled Payment: An AHA Research Synthesis Report, is the first in a series of reports presented by the American Hospital Association Committee on Research. These reports synthesize key literature on issues relating to the AHA's 2010-2012 research agenda. The Committee on Research also serves as the board of trustees for HRET (Health Research & Educational Trust).