Key References
Proposals
1. Senate Finance Committee (2009) Description of Policy Options: Transforming the Health
Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs.
Retrieved from:
http://finance.senate.gov/sitepages/leg/LEG%202009/042809%20Health%20Care%20Descr
iption%20of%20Policy%20Option.pdf
Summary: This proposal advocates for a bundled payment to be made for acute services and
post-acute services occurring or initiated within 30 days of discharge from a hospital. This
approach would involve a three-phase implementation, separated by two years. In phase one,
bundled payments would be applied to the top 20 percent of post-acute spending; in phase two,
bundled payments would be applied to the next 30 percent of post-acute spending; and in
phase three, bundled payments would be applied to the last 50 percent of post-acute spending.
Bundled payments will total inpatient MS-DRG amount plus post-acute care costs for the same
MS-DRG and will be paid to an established legal entity, including a hospital.
2. Office of Management and Budget (2009) A New Era of Responsibility: Renewing America’s
Promise. Retrieved from:
http://www.whitehouse.gov/omb/assets/fy2010_new_era/a_new_era_of_responsibility2.pdf
Summary: The president’s budget proposes bundled payments as an approach to reducing
preventable rehospitalizations. The bundled payments will cover hospitalizations as well as
post-acute care 30 days after the hospitalization. Additionally, hospitals with a high rate of
readmissions within the 30-day period will be paid less.
3. Guterman, S., Davis, K., Schoen, C., and Stremikis, K. (2009) Reforming Provider Payment:
Essential Building Block for Health Reform. (Fund Publication 1248). Retrieved from the
Commonwealth Fund:
http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2009/Mar/12
48_Guterman_reforming_provider_payment_essential_building_block_FINAL.pdf
Summary: This proposal suggests a global fee for hospitalization and a “specified set of
services for 30 days following discharge.” This approach would be phased in starting in 2010;
the first stage would involve bundled payment for hospital costs associated with initial
hospitalization and any readmissions that occur within 30 days of discharge and follow up care
for the patient. The second stage would involve bundled payments for acute and post-acute
care, and the final stage would involve a bundled payment for acute care, physician services,
post-acute care, and emergency room care.
4. MedPAC (2008) A path to bundled payment around a hospitalization. In Report to Congress:
Reforming the Delivery System (pp. 83-103). Retrieved from:
http://www.medpac.gov/documents/Jun08_EntireReport.pdf
