Association of bundled payments with spending, utilization, and quality for surgical conditions: A scoping review

Ahmad M Hider; Amalia E Gomez-Rexrode; Josh Agius; Mark P MacEachern; Andrew M Ibrahim; Scott E Regenbogen; Nicholas L Berlin

doi:10.1016/j.amjsurg.2023.12.009

Association of bundled payments with spending, utilization, and quality for surgical conditions: A scoping review

Am J Surg. 2024 Mar:229:83-91. doi: 10.1016/j.amjsurg.2023.12.009. Epub 2023 Dec 14.

Authors

Ahmad M Hider¹, Amalia E Gomez-Rexrode¹, Josh Agius², Mark P MacEachern³, Andrew M Ibrahim⁴, Scott E Regenbogen⁵, Nicholas L Berlin⁶

Affiliations

¹ University of Michigan Medical School, Ann Arbor, MI, USA.
² University of Michigan, Ann Arbor, MI, USA.
³ Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA.
⁴ VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
⁵ Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
⁶ Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA. Electronic address: nberlin@med.umich.edu.

PMID: 38148257
DOI: 10.1016/j.amjsurg.2023.12.009

Abstract

Objectives: To assess the body of literature examining episode-based bundled payment models effect on health care spending, utilization, and quality of care for surgical conditions.

Background summary: Episode-based bundled payments were developed as a strategy to lower healthcare spending and improve coordination across phases of healthcare. Surgical conditions may be well-suited targets for bundled payments because they often have defined periods of care and widely variable healthcare spending. In bundled payment models, hospitals receive financial incentives to reduce spending on care provided to patients during a predefined clinical episode. Despite the recent proliferation of bundles for surgical conditions, a collective understanding of their effect is not yet clear.

Methods: A scoping review was conducted, and four databases were queried from inception through September 27, 2021, with search strings for bundled payments and surgery. All studies were screened independently by two authors for inclusion.

Results: Our search strategy yielded a total of 879 unique articles of which 222 underwent a full-text review and 28 met final inclusion criteria. Of these studies, most (23 of 28) evaluated the impact of voluntary bundled payments in orthopedic surgery and found that bundled payments are associated with reduced spending on total care episodes, attributed primarily to decreases in post-acute care spending. Despite reduced spending, clinical outcomes (e.g., readmissions, complications, and mortality) were not worsened by participation. Evidence supporting the effects of bundled payments on cost and clinical outcomes in other non-orthopedic surgical conditions remains limited.

Conclusions: Present evaluations of bundled payments primarily focus on orthopedic conditions and demonstrate cost savings without compromising clinical outcomes. Evidence for the effect of bundles on other surgical conditions and implications for quality and access to care remain limited.

Publication types

Review

MeSH terms

Delivery of Health Care
Episode of Care
Hospitals
Humans
Medicare
Patient Care Bundles*
Reimbursement Mechanisms*
United States

Grants and funding

R01 HS028606/HS/AHRQ HHS/United States