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Bundled Payments

Bundled Payments: Are Some Models Better Than Others?

As the development of alternative payment models are being encouraged, specialists are in a unique position to actively participate in the development process. Bundled payments represent one such model for reimbursement and management of chronic disease, but there are no clear recommendations on bundled payment design, and research on bundled payments for dermatologic care is limited.

Bundled payments are a one-time reimbursement that encompasses all the care of a particular condition for a particular patient for a specific period. These payments encompass patient evaluation, laboratory testing, medications, and also procedures which may be delivered by a diverse group of health care professionals in more than one setting. There are no standard methods for developing bundled payments. Some methods have included using the mean or a percentile threshold of historical claims; they can also be case adjusted, meaning the dollar amount can be adjusted depending on the characteristics and comorbidities of a particular patient. Other important considerations are the episode of care duration, criteria for patient inclusion, and services included (and excluded) by the bundled payment. Bundled payments are often associated with surgical procedures, such as orthopedic procedures.

A recent study investigated several methods to develop bundled payment models for actinic keratosis (AK) management and the likely effect on the cost of AK management. Eight bundled payment models, all based on one year of care, were developed.  The models were applied to two validation data sets to assess the performance of the models in other patient groups. The bundled payment that covered the largest proportion of patients in all samples was a payment based on the sample’s 75th percentile payment, however this actually resulted in a projected increased cost for AK care. The payment that covered the smallest proportion of patients was a median-based payment. Six of the 8 bundled payment models tested projected decreases in health care costs for actinic keratosis management.

The authors conclude that while bundled payment models can use economic principles to consider population health, evidence-based management, and patient-centered measures of quality and cost, they are complex, and implementation requires many considerations. They note that dermatology as a field needs to understand disease management in dollar terms in order to advocate on behalf of both clinicians and patients for fair and reasonable reimbursement, regardless of the type of payment.


Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: August 23, 2016

Source: JAMA Dermatology
Adapted from the original article.

[Image: Pixabay / Bykst]

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