Bundled Payments

Understanding the Basics of Bundled Payments in Healthcare

December 26, 2023 - The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment fades away, alternative payment models like bundled payments are helping to define the future of revenue cycle management. Bundled...


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AHA Calls for Easier On-Ramp for Bundled Payments, Episode-Based Payments

by Sara Heath

The American Hospital Association wants it to be easier for hospitals nationwide to begin adopting episode-based payment models, such as bundled payments, the trade association wrote in a recent letter...

Lower Clinical Spending Needed in BPCI-A Program to Avoid Losses

by Victoria Bailey

Hospitals and physician groups participating in the Bundled Payments for Care Improvement Advanced (BPCI-A) program would have had to reduce clinical spending by 3.7 percent to 8.2 percent during the...

Bundled Payment Model Reduced Spending on Medical, Surgical Episodes

by Victoria Bailey

Participating in Medicare’s Bundled Payments for Care Improvement (BPCI) initiative was associated with cost savings for medical and surgical episodes, but savings varied among hospitals and...

Cancer Care Alternative Payment Model Didn’t Reduce Novel Drug Use

by Jacqueline LaPointe

Clinicians participating in alternative payment models must keep a close eye on the cost of care. However, that is not at the expense of novel anticancer drug use in the Oncology Care Model (OCM), a...

CMS Delays Radiation Oncology Model With No New Start Date

by Jacqueline LaPointe

The Radiation Oncology Model has been delayed indefinitely under a final rule released by CMS on Thursday. The alternative payment and care delivery model for cancer care aims to improve quality of...

Advanced Bundled Payment Model Reduced Medicare Episode Payments

by Victoria Bailey

The CMS Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model reduced Medicare fee-for-service episode payments for both surgical and medical episodes, according to a new report for CMS...

What Is Value-Based Care, What It Means for Providers?

by Editorial Staff

Value-based care is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness. This form of reimbursement has emerged as an alternative and...

For-Profit Hospitals Use Conveners for Bundled Payment Success

by Jacqueline LaPointe

The use of conveners for bundled payment success is more common among non-teaching and for-profit hospitals, and those that use conveners tend to select more episodes with higher target prices,...

Risk Stratification Of Bundled Payment Models Requires Clinical Data

by Hannah Nelson

Incorporating clinical data into risk stratification could improve the accuracy of CMS bundled payment models like the Oncology Care Model (OCM), according to a new Avalere analysis. The OCM is a...

CMS Pushes Back Launch of Radiation Oncology Model

by Jacqueline LaPointe

CMS recently announced via email that it intends to delay the start of the Radiation Oncology Model after receiving feedback from stakeholders. “CMS has received feedback from a number of...

Major Changes Coming to BPCI Advanced Clinical Episodes, Prices

by Jacqueline LaPointe

CMS is making major changes to Bundled Payments for Care Improvement (BPCI) Advanced next year to stop the model from generating financial losses of close to $2 billion over the model’s ten...

CMS Releases Initial Report on Risk-Based Bundled Payment Model

by Jacqueline LaPointe

Hospitals and physician group practices (PGPs) participating in the first two cohorts of the Bundled Payments for Care Improvement (BPCI) Advanced have a good chance of reducing episode payments....

Third of Execs Don’t Think Value-Based Payment Will Usurp FFS

by Jacqueline LaPointe

Value-based payment adoption has steadily increased, but a third of healthcare executives in a new survey do not believe the alternative payment mechanism will usurp fee-for-service. Fee-for-service...

Alternative Payment Models Save, But Drop-Out Rate Still a Concern

by Jacqueline LaPointe

Alternative payment models (APM) primarily run by Medicare have generally produced modest savings and quality improvements. However, popular APMs including accountable care organization (ACO) and...

CMS Seeks Extension for Comprehensive Care for Joint Replacement

by Jacqueline LaPointe

The Comprehensive Care for Joint Replacement (CJR) Model is slated to sunset by the end of the year, but a recently proposed rule from CMS would extend the bundled payment program for another three...

Practices in Oncology Care Model Ready to Assume Two-Sided Risk

by Samantha McGrail

Oncology practices participating in CMS’ Oncology Care Model (OCM) are willing to take on two-sided risk, according to a survey conducted by the Community Oncology Alliance (COA).  The...

Sutter Health, CA Reach $575M Settlement Over Anti-Trust Concerns

by Samantha McGrail

California Attorney General Xavier Bacerra recently announced a $575 million settlement with Sutter Health to resolve the health system’s alleged anti-trust behaviors, which a class action...

Medicare Oncology Care Model Needs Refinement to Boost Reach

by Samantha McGrail

Medicare’s Oncology Care Model (OCM) is a promising start to payment reform for oncology care but the model needs several vital changes to improve the model’s effectiveness and reach across...

Radiation Oncology Bundle Inaccurately Predicts Some Cancer Costs

by Samantha McGrail

A proposed bundled payment model for radiation oncology cold underestimate payments for prostate cancer, a new analysis from Avalere,  finds.  The healthcare consulting firm based in...