Medicare’s Bundled Payment Models—Progress and Pitfalls

Maddox et al consider how the bundled payment programs from the US Centers for Medicare and Medicaid Services (CMS) require close examination of benchmarks, market distortions, and health equity. CMS is moving increasingly toward alternative payment models that incentivize high-quality, low-cost care. Bundled payments, for example, now cover medical, procedural, and therapeutic episodes, from a broad range of medical and surgical conditions in Bundled Payments for Care Improvement Advanced to hip and knee replacements in the Comprehensive Care for Joint Replacement Model; to chemotherapy administration in the Oncology Care Model. Bundled payments encourage cost efficiency by setting a total spending benchmark for all services associated with a clinical "episode."