Resumen de Medicare’s Bundled Payment Program and Health Care Utilization

William B. Weeks, Matthew J. Press, Rahul Rajkumar, Patrick H. Conway

• English

  Dr Press and colleagues1 described Medicare’s bundled payment program and acknowledged that the program may incentivize inappropriate overuse, restrict care to certain (presumably low-risk) groups, and shift care outside the episode—unintended consequences of bundled payment reimbursement strategies that have been raised before.2 But implementing bundled payments without requiring processes that “incorporate shared decision making, patient-reported outcomes, and clinical appropriateness”1 is a recipe for overuse and cost escalation.

• English

  Dr Weeks expresses concern that without appropriate safeguards, the new bundled payment models developed by the Centers for Medicare & Medicaid Services (CMS) will lead to increased utilization and, therefore, costs. He asserts that although bundled payment incentivizes lower spending during the episode of care, health care organizations will compensate by increasing the number of episodes of care initiated.

  We agree with Weeks that patients should “get only the care that they want and need” and, as discussed in our Viewpoint, recognize the potential for unintended consequences with bundled payment models. As such, CMS incorporates a number of safeguards into the design of these models and conducts rigorous, multifaceted evaluations that examine several key areas of interest. To date, independent evaluation of the Bundled Payments for Care Improvement (BPCI) initiative models 2 through 4 has not yet conclusively identified any unintended consequences. But CMS will continue to monitor carefully for any evidence of overuse, shifting, steering, or stinting in care. In addition, the design of the BPCI and the Comprehensive Care for Joint Replacement models allows for CMS to recoup excessive spending during the postepisode period, which could be due to shifting or delaying care.