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January 23/30, 2018

The Rise and Fall of Mandatory Cardiac Bundled Payments

Author Affiliations
  • 1Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
  • 2Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, Massachusetts
  • 3Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
  • 4Associate Editor, JAMA
JAMA. 2018;319(4):335-336. doi:10.1001/jama.2017.19205

Bundled payments, a type of alternative payment model in which payments for all services provided in a care episode are linked, represents a promising approach to improving the coordination and efficiency of care. In December 2016, the Centers for Medicare & Medicaid Services (CMS), building on a 3-year-old voluntary bundled payment program, announced new mandatory bundled payment models for selected hospitals providing acute myocardial infarction care and coronary artery bypass graft surgery. The mandatory cardiac bundles were to start in 2018, but in late 2017, CMS released a rule cancelling the program.1 In this Viewpoint we review the rationale for mandatory bundled payments and argue that their cancellation was a step in the wrong direction for pursuing a health care system that focuses on value and not volume.