Bundled Payments in U.S. Healthcare System

In January 2018, the Centers for Medicare and Medicaid Services (CMS) announced an new voluntary bundled payment model, which meant transforming the reimbursement system in the U.S. healthcare sector from the Fee-For-Service to Value-Based method would be continued.

The general public has been curious about what is really happening to the U.S. current healthcare reimbursement system with a new administration with the new administration. The good new is that transforming the reimbursement system in the healthcare sector from the Fee-For-Service to Value-Based method was confirmed to be continued when the Centers for Medicare and Medicaid Services (CMS) announced an new voluntary bundled payment model on January 10, 2018. Even though the first year of Trump administration was relatively turbulent to the healthcare sector, it was a welcoming news that the federal agency would continue the pilot studies to build and polish the value-based reimbursement criteria. Though CMS did cancel two bundle programs in 2017, it is now committed to roll out 32 clinical episode studies, 29 and three of which are inpatient and outpatient, respectively.


More pilot studies are still needed to test the Bundle Payment for Care Improvement Advanced (BPCI-A) model. CMS is asking all participating providers (e.g. hospitals, clinics) to stay in the bundle program trials for at least one year, which was longer than in the past. This initiative would ensure more quality data would be collected in order to evaluate the efficiency of the Value-Based model. Thankfully, many hospitals are now seeing the necessity of implementing value-based care in order to control the rapidly increasing medical costs. The momentum is fueling the movement toward the Performance-Based, Patient-Centric pathway against current political atmosphere and the significant requirement of time and efforts.

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