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Bundled Payments for Bariatric Surgery

  • C. Joe Northup
  • John David ScottEmail author
Chapter

Abstract

A bundled payment model is a method of reimbursement in which a single, comprehensive payment is made for a solitary episode of care. Multiple models for bundling services and payments have been developed across a wide variety of surgical services, including coronary bypasses and joint replacements. In 2011, the Centers for Medicaid and Medicare Services (CMS) proposed the Bundled Payments for Care Improvement Initiative (BPCI) to stimulate development of new prospective payment strategies. This proposal was presented with the anticipation of uniting hospitals and providers to focus on coordinated patient management and no longer emphasize payment based solely on volume of care. Four separate bundled payment models were proposed and have been slowly introduced into practice over the past several years. Private entities and regional/state-level healthcare insurers are also developing similar bundling models based on lessons learned from the CMS experience. The four main concerns of bundled payment plan creation include the identification of trigger episodes, determination of cost, establishment of gain sharing, and limiting exposure to risk through adjustment. Bariatric surgery is a procedure that is amenable to bundled payment creation due to its relatively low complication rate and protocol-driven care. Bariatric surgeons should be familiar with the components and the language of bundled payment construction plans so that they might be more approachable as a resource during their development. Bariatric surgeons should advocate for protecting the access to care interests of their patients in addition to limiting the financial risks to providers and their affiliated healthcare facilities.

Keywords

Bundling Payment systems Risk adjustment Episodic care Trigger episodes Gain sharing Prospective payment systems Cost sharing Reimbursement modeling 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Premier Weight Loss Solutions, Premier HealthCentervilleUSA
  2. 2.Division of Minimal Access and Bariatric Surgery, Department of SurgeryGreenville Health SystemGreenvilleUSA

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