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September 30, 2020

Going Beyond One Size Fits All in Surgical Bundled Payments

Author Affiliations
  • 1Department of Medicine, University of Washington School of Medicine, Seattle
  • 2Value & Systems Science Lab, Seattle, Washington
  • 3Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
  • 4Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
  • 5Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 6University of Pittsburgh Medical Center (UPMC) Heart & Vascular Institute, Pittsburgh, Pennsylvania
JAMA Surg. Published online September 30, 2020. doi:10.1001/jamasurg.2020.1948

Bundled payments have particular relevance to surgeons. Medicare has used several nationwide programs to implement the payment model for a range of procedures, holding surgeons in group practices and hospitals financially accountable for care episodes defined by a procedure, hospitalization, and 90 days of postacute care. Existing evidence is encouraging, with organizations participating in joint replacement bundles achieving 2% to 4% savings per episode with stable quality.

Both surgeons and payers could benefit from scaling bundled payments to a broader range of procedures and patients. Surgeons can use the payment model to improve care coordination and outcomes. For payers, understanding the impact of different procedures is critical to informing future policy. However, the current design of bundled payment policies may limit surgeons’ participation and impede progress toward these goals.

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