The Centers for Medicare & Medicaid Services (CMS) recently cancelled the mandatory cardiac bundled payments that were set to start in early 2018 for selected hospitals providing acute myocardial infarction care and coronary artery bypass graft surgery. However, a mandatory bundled payment program could be associated with greater collaboration and engagement among hospitals and physicians, innovative redesigns of current care processes, and significant cost savings, according to a paper published in JAMA.

Bundled payments were introduced as a means of reducing rising healthcare costs associated with the fee-for-service model, primarily by offering a fixed or target payment for each care episode. The Bundled Payments for Care Improvement initiative was a voluntary program created by the Center for Medicare and Medicaid Innovation in 2013 that offered 4 tracks, including 48 clinical episodes (eg, acute myocardial infarction, hip surgery, and diabetes), 3 different episode lengths (30, 60, and 90 days), and different care phases (eg, hospitalization and associated readmissions vs hospitalization and postdischarge care vs postacute care only).

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Voluntary bundled payment initiatives are more likely to be implemented in centers that will experience the most benefit. Although these programs hold some promise, the voluntary nature of such an initiative presents some issues, including low enrollment and early program termination. Therefore, voluntary bundled payments may not demonstrate any meaningful change in the delivery of care. The researchers note that without testing a bundled payment model across a group of representative acute care hospitals, it is difficult to gain insight into the design of effective payment programs.

The CMS developed a mandatory bundled payment model for a number of hospitals offering care for acute myocardial infarction and coronary artery bypass graft surgery, which was set to launch in 2018. Despite the potential for this initiative to curb the rising tide of healthcare costs, the program was cancelled.

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The authors suggest that the current state of healthcare costs cannot be ignored, and without a mandate and a goal in sight, hospitals, postacute care facilities, and clinicians will “have little motivation to collaborate around innovative care redesign to improve coordination and efficiency.”


Wadhera RK, Yeh RW, Maddox KEJ. The rise and fall of mandatory cardiac bundled payments [published online January 11, 2018].  JAMA. doi: 10.1001/jama.2017.19205