Bundled Payments: Everything Old is New Again

Medicare bundled payment initiatives are in the news again.  Overall, I welcome further experimentation in this regard.

But I also wonder what, if anything, we've learned from ongoing experiments with Medicare bundled (prospective)payments for Medicare beneficiaries with end-state renal failure/dialysis ("ESRD"). It has been more than a few decades now that Medicare has taken on this entire population simply defined by disease state or diagnosis. And it has been at least since 2011 that, under that rubric, Medicare has experimented with bundled payments for this group.

Like Dr. Phil McGraw, I often think the best question to ask is "How's that workin' for ya?"  Working well might mean satisfying the goals of comprehensive coverage to begin with or serving a diverse population equitably or serving this population at a price point that improves upon Medicare's original fee for service approach to dialysis payment.

As far as I  can tell, though Medicare enrollment for this group is up, costs have remained constant. Performance indicators began to improve in 2011.So, why don't we talk about it more? Because it seems so precarious as payment for the ESRD bundle is a perennial reimbursement arguing point? Or, is it that we are uncertain consolidation in dialysis providers is an unambiguously good thing or that that the drive to home-based peritoneal dialysis served many beneficiaries well?


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