Title

Policy makers will need a way to update bundled payments that reflects highly skewed spending growth of various care episodes

UMMS Affiliation

Department of Quantitative Health Sciences; Meyers Primary Care Institute

Date

5-2013

Document Type

Article

Medical Subject Headings

Health Expenditures; Fees and Charges; Economics, Medical; Health Policy

Disciplines

Health and Medical Administration | Health Economics | Health Services Administration

Abstract

Bundled payment entails paying a single price for all services delivered as part of an episode of care for a specific condition. It is seen as a promising way to slow the growth of health care spending while maintaining or improving the quality of care. To implement bundled payment, policy makers must set base payment rates for episodes of care and update the rates over time to reflect changes in the costs of delivering care and the components of care. Adopting the fee-for-service paradigm of adjusting payments with uniform update rates would be fair and accurate if costs increased at a uniform rate across episodes. But our analysis of 2003 and 2007 US commercial claims data showed spending growth to be highly skewed across episodes: 10 percent of episodes accounted for 82.5 percent of spending growth, and within-episode spending growth ranged from a decline of 75 percent to an increase of 323 percent. Given that spending growth was much faster for some episodes than for others, a situation known as skewness, policy makers should not update episode payments using uniform update rates. Rather, they should explore ways to address variations in spending growth, such as updating episode payments one by one, at least at the outset.

Comments

Citation: Health Aff (Millwood). 2013 May;32(5):944-51. doi: 10.1377/hlthaff.2012.1246. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

23650329