The Centers for Medicare & Medicaid Services (CMS) is about to try four different strategies for bundling provider payments.
CMS is organizing the Bundled Payments for Care Improvement testing program to implement Section 3021 of the Patient Protection and Affordable Care Act of 2010.
PPACA Section 3021 requires CMS to try to hold down the cost of care by experimenting with new strategies for paying for care.
Recommended For You
Section drafters wrote the section because of concerns that one reason for the high cost of the U.S. acute health care system may be the typical fee-for-service approach to paying for care, especially at the traditional Medicare program.
The four models to be tested are:
- Model 1: "Hospital services provided to a beneficiary during an acute inpatient stay, where physicians are partners in improving care."
- Model 2: "Hospital, physician, post-acute provider, and other Medicare-covered services provided during the inpatient stay as well as during recovery after discharge to the home or another care setting."
- Model 3: "Hospital, physician, post-acute provider, and other Medicare-covered services beginning with the initiation of post-acute care services after discharge from an acute inpatient stay."
- Model 4: "Prospective Payment Bundling… CMS would make a single, prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians and other practitioners. Physicians and other practitioners would submit 'no-pay' claims to Medicare and would be paid by the hospital out of the bundled payment."
Private health plans and health insurers do not have to take any actions as a result of the bundled payments program, but policymakers are hoping that, if CMS comes up with any successful strategies for holding down costs, other payers will follow suit.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
