The process of bundled payments — in which hospitals, physicians, post-acute care providers and other receive a lump sum to cover a specific episode of care over an allotted period of time — is still in its infancy stages. But what exactly can hospitals expect to be paid if they decide to move forward with the process for Medicare patients?
The American Hospital Association and the Association of American Medical Colleges commissioned Dobson DaVanzo & Associates to look at bundled payments and provide analysis on different episode-based payment bundles that providers could expect.
The study looked at 16 MS-DRG families that represent a significant portion of Medicare's fee-for-service payments. Dobson DaVanzo analysts looked at the data on each of the selected MS-DRG families from 2007 to 2009 for a 30-day fixed-length episode. Here are the average bundled payments hospitals and other providers would expect to get for those 16 groups, standardized to 2009 dollars.
Note: Episode payments factored in several variables, such as relative variability and whether conditions have clear, evidence-based practice guidelines. To learn more about the AHA/AAMC analysis on bundled payments, click here.
Major joint replacement / reattachment of lower extremity
Percent of Medicare episodes: 4.7 percent
Average episode payment: $19,631
Heart failure and shock
Percent of Medicare episodes: 4.7 percent
Average episode payment: $12,006
Simple pneumonia and pleurisy
Percent of Medicare episodes: 3.9 percent
Average episode payment: $10,381
Chronic obstructive pulmonary disease
Percent of Medicare episodes: 3.7 percent
Average episode payment: $9,382
Intracranial hemorrhage or cerebral infarction
Percent of Medicare episodes: 2.4 percent
Average episode payment: $16,681
Hip and femur procedures except major joint
Percent of Medicare episodes: 1.5 percent
Average episode payment: $24,432
Percutaneous cardiovascular procedure with drug-eluting stent
Percent of Medicare episodes: 1.3 percent
Average episode payment: $13,568
Coronary bypass with cardiac cath
Percent of Medicare episodes: 0.4 percent
Average episode payment: $39,646
Revision of hip or knee replacement
Percent of Medicare episodes: 0.4 percent
Average episode payment: $24,121
Cardiac valve and other major cardiothoracic procedures without cardiac cath
Percent of Medicare episodes: 0.3 percent
Average episode payment: $44,926
Coronary bypass without cardiac cath
Percent of Medicare episodes: 0.3 percent
Average episode payment: $29,534
Cardiac valve and other major cardiothoracic procedures with cardiac cath
Percent of Medicare episodes: 0.2 percent
Average episode payment: $58,075
Bilateral or multiple major joint procedures of lower extremity
Percent of Medicare episodes: 0.1 percent
Average episode payment: $30,281
Nonspecific cerebrovascular accident and precerebral occlusion without infarction
Percent of Medicare episodes: 0.1 percent
Average episode payment: $10,533
Acute ischemic stroke with use of thrombolytic agent
Percent of Medicare episodes: 0.1 percent
Average episode payment: $24,599
Coronary bypass with percutaneous transluminal coronary angioplasty
Percent of Medicare episodes: Less than 0.1 percent
Average episode payment: $50,720
The American Hospital Association and the Association of American Medical Colleges commissioned Dobson DaVanzo & Associates to look at bundled payments and provide analysis on different episode-based payment bundles that providers could expect.
The study looked at 16 MS-DRG families that represent a significant portion of Medicare's fee-for-service payments. Dobson DaVanzo analysts looked at the data on each of the selected MS-DRG families from 2007 to 2009 for a 30-day fixed-length episode. Here are the average bundled payments hospitals and other providers would expect to get for those 16 groups, standardized to 2009 dollars.
Note: Episode payments factored in several variables, such as relative variability and whether conditions have clear, evidence-based practice guidelines. To learn more about the AHA/AAMC analysis on bundled payments, click here.
Major joint replacement / reattachment of lower extremity
Percent of Medicare episodes: 4.7 percent
Average episode payment: $19,631
Heart failure and shock
Percent of Medicare episodes: 4.7 percent
Average episode payment: $12,006
Simple pneumonia and pleurisy
Percent of Medicare episodes: 3.9 percent
Average episode payment: $10,381
Chronic obstructive pulmonary disease
Percent of Medicare episodes: 3.7 percent
Average episode payment: $9,382
Intracranial hemorrhage or cerebral infarction
Percent of Medicare episodes: 2.4 percent
Average episode payment: $16,681
Hip and femur procedures except major joint
Percent of Medicare episodes: 1.5 percent
Average episode payment: $24,432
Percutaneous cardiovascular procedure with drug-eluting stent
Percent of Medicare episodes: 1.3 percent
Average episode payment: $13,568
Coronary bypass with cardiac cath
Percent of Medicare episodes: 0.4 percent
Average episode payment: $39,646
Revision of hip or knee replacement
Percent of Medicare episodes: 0.4 percent
Average episode payment: $24,121
Cardiac valve and other major cardiothoracic procedures without cardiac cath
Percent of Medicare episodes: 0.3 percent
Average episode payment: $44,926
Coronary bypass without cardiac cath
Percent of Medicare episodes: 0.3 percent
Average episode payment: $29,534
Cardiac valve and other major cardiothoracic procedures with cardiac cath
Percent of Medicare episodes: 0.2 percent
Average episode payment: $58,075
Bilateral or multiple major joint procedures of lower extremity
Percent of Medicare episodes: 0.1 percent
Average episode payment: $30,281
Nonspecific cerebrovascular accident and precerebral occlusion without infarction
Percent of Medicare episodes: 0.1 percent
Average episode payment: $10,533
Acute ischemic stroke with use of thrombolytic agent
Percent of Medicare episodes: 0.1 percent
Average episode payment: $24,599
Coronary bypass with percutaneous transluminal coronary angioplasty
Percent of Medicare episodes: Less than 0.1 percent
Average episode payment: $50,720
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AHRQ: Bundled Payments May Lead to Lower Healthcare Costs