Medicare’s Bundled Payment Models—Progress and Pitfalls

JAMA Network April 22, 2022
Karen E. Joynt Maddox, MD, MPH; Sukruth A. Shashikumar, AB; Andrew M. Ryan, PhD

The Centers for Medicare & Medicaid Services (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 (BPCI-A); to hip and knee replacements in the Comprehensive Care for Joint Replacement Model (CJR); to chemotherapy administration in the Oncology Care Model (OCM). Bundled payments encourage cost efficiency by setting a total spending benchmark for all services associated with a clinical “episode.” In the full risk-bearing phase of these and other similar programs, if model participants reduce average costs below their benchmark, CMS rewards them with a financial bonus; if their costs...

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