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June 20, 2017

The Next Generation of Episode-Based Payments

Author Affiliations
  • 1Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania
  • 2Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Massachusetts General Hospital, Harvard Medical School, Boston
  • 4Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia
JAMA. 2017;317(23):2371-2372. doi:10.1001/jama.2017.5902

On December 20, 2016, the US Department of Health and Human Services (DHHS) announced the final models for the next group of mandatory episode-based payments. All hospitals accepting Medicare patients in 98 metropolitan areas will be required to accept bundled payments, which include a fixed payment for hospital care plus services for the 90 days following discharge of patients with acute myocardial infarction and coronary artery bypass graft surgery.1 Even though the future of bundled payments remains uncertain, as illustrated by the recent delay in DHHS implementation of mandatory cardiac bundles until October 2017, episode-based payments are a fundamental component of alternate payment models currently being instituted by Medicare and private payers.