Medicare's Step Back from Global Payments — Unbundling Postoperative Care

New England Journal of Medicine 372(15):1385 (2015) PMID 25839843

Owing to concerns about the accuracy of payments for postoperative care, the Centers for Medicare and Medicaid Services has announced that surgeries for which it has bundled payments for care during a 10- or 90-day global period will be shifted to a 0-day global period. Many experts believe that the U.S. health care system's continued dependence on fee-for-service payments is a key driver of excessive health care spending. Bundled payment, or payment of predetermined amounts for sets of related services, is one potential solution. In theory, bundled payments create incentives to reduce the use of unnecessary care while preserving treatment flexibility and reducing the administrative burden for provider organizations and payers.1 Research suggests that bundling payments leads to modest reductions in spending without negatively affecting the quality of care.2 Medicare has gradually embraced bundled payment over the past three decades. The inpatient prospective payment system . . .

DOI: 10.1056/NEJMp1415483