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Are bundled payments a sure thing?

March 2017
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Published in the March 2017 issue of Today’s Hospitalist

For years, we’ve heard that bundled payments are the future of U.S. health care. That’s good news for hospitalists because the specialty plays such an integral role in making hospitals efficient enough to turn a profit.

Bundled payments have been a particularly good match for hospitalists’ skills because many bundles focus on orthopedics. With hospitalist programs pioneering orthopedic comanagement for years, bundled payments play to their strengths.

So when hospitals and hospitalist groups gear up for the next wave of mandatory bundles, which target hip-fracture repair and cardiac care, it’s easy to see how hospitalists may benefit. That’s also why this month’s cover story looks at hospitalist strategies for making bundles work.

But now there are questions about whether bundled payments—particularly those being mandated in orthopedics and cardiac care—will survive the new administration. The newly confirmed Secretary of Health and Human Services has voiced his opposition to mandatory bundled payment programs.

And let’s not forget that all bundled payment initiatives, mandatory or otherwise, are part of the Affordable Care Act, which the current administration and the Congress have vowed to repeal. It’s unclear how-when-if the ACA will change, but the effects of any change on hospital financing could be profound.

Experts believe that bundled payments will survive any repeal effort because they improve care and save money. But the push to raising your game to succeed at managing bundles could dissipate if mandatory bundles are axed.

While hospitals and doctors always want to improve care, it’s no secret that they prioritize must-dos over want-to-dos. If mandatory bundles go away, the urgency that many hospitalist programs now have to put new protocols in place and streamline communications would inevitably slow down. Conventional wisdom may hold that bundled payments are here to stay—but in the current political environment, conventional wisdom keeps being proven wrong.

edoyleEdward Doyle
Editor & Publisher
edoyle@todayshospitalist.com