March 2, 2018 | Healthcare Analytics News
CMS is Leading the Way Toward Bundled Payments. Should It Be?
“The irony of Price’s objection to mandatory payment bundles—that they are ‘experiments’—is the reason why many in healthcare like them. Doctors are scientists, and scientists experiment. ‘The beauty of the mandatory bundle for joint and cardiac procedures is that you basically have a randomized trial where you can see [whether] bundles increase the volume of procedures, [whether] hospitals are able to save money, and [whether] quality is maintained,’ Ezekiel Emanuel, MD, told HCA in an interview. ‘You get real data.’
Emanuel, the founding chair of the Department of Bioethics at the National Institutes of Health and vice provost for global initiatives at the University of Pennsylvania, takes credit for working behind the scenes to launch the OCM, and he has also published studies and opinion letters regarding the efficacy of the joint replacement bundles.
‘What happens with voluntary?’ he asked. ‘Who is going to participate? Someone who thinks they’re going to succeed. It’s not a random sample, and it doesn’t get those people who are sitting on the sidelines waiting, the [major for-profit health systems]. You’ve got to get those people to play the game.’
To Amol Navathe, MD, PhD, that self-selection problem is troubling. A colleague of Emanuel’s at the University of Pennsylvania, the healthcare economist has studied bundled payments for years. Hospitals that choose to participate in bundled payment programs are most often high-volume, nonprofit, and urban. Few safety-net or for-profit hospitals have done the same.”