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Click here for more sample CPC practice exam questions and answers with full rationale

Do Bundled Payments Keep Costs Down?

As a matter of fact, it appears that they do. According to a pair of researchers from the University of Pennsylvania, bundled payments resulted in both better care and lower costs for hospitals despite fear that the opposite would be true in both cases.

The researchers analyzed nearly two million claims of Medicare patients who had undergone lower extremity joint replacement, or LEJR. Across these claims, a portion of the hospitals in question participated in Medicare’s Bundled Payments for Care Improvement (BPCI) plan, while the others did not. Regardless of whether or not the facilities participated, there was no major difference in the amount of reimbursement they received, but the bundled payments made it easier to file the proper claims.

BCPI, introduced as part of the Affordable Care Act (ACA), allows hospitals to receive a single bundled reimbursement amount for the patient’s operation and corresponding global period. The facility itself is then responsible for distributing the money between all parties involved, including the surgeon, anesthesiologists, and any auxiliary staff members. The initial fear was that this would lead to distribution issues and potentially even encourage hospitals to perform extra, unnecessary surgeries in order to gain more revenue, but there has been no evidence to support either of these claims.

Additionally, BCPI gives facilities the options to opt in or out, so no hospital is required to participate if they fear that it will hurt their profits or productivity. With these new results, however, many facilities would do well to look more into the program and consider joining, as doing so will make life easier for patients, providers, and administrators alike. In the meantime, more organization continue to conduct research and study bundled payments in hopes of determining what courses of action will have the best possible impact on healthcare in the future.