Summary: Two of the authors on this report are on the Medicare Payment Advisory Commission
(MedPAC). The article provides further commentary on MedPAC’s recommendation for
bundling payments. According to the authors, to ensure ”joint accountability for both the volume
and the costs of services, payment for physician services as well as hospital and other post-acute services” must be included in a bundle. The authors however highlight that before this
payment approach can be implemented, several questions need to be answered, such as
whether hospitals and physicians will be able to collaborate and form an entity that can accept
and divide a bundled payment.
17. Davis, K. (2007) Paying for Care Episodes and Care Coordination. The New England
Journal of Medicine, 356:1166-1168.
Summary: In this article, Karen Davis advocates for instituting a global fee for care episodes as
a way to reduce variation in payments for acute episodes or for care for patients with chronic
conditions. The global fee would cover hospital services, physician services, and other services
required for treating acute conditions. A major issue identified by the paper in designing such a
system would be how to appropriately assign accountability for care across different settings
over time. The author cautions that given the fragmentation of the health system and lack of
continuity in patient-physician relations, new payment policies such as bundling payments
should be extensively evaluated before being implemented.
18. Kulesher, R. R. and Wilder, M. G. (2006) Prospective Payment and the Provision of Post-Acute Care: How the Provisions of the Balanced Budget Act of 1997 Altered Utilization
Patterns for Medicare Providers. Journal of Health Care Finance, 33: 1-16.
Summary: This study assesses the preliminary impact of extending the prospective payment
system to skilled nursing facilities and home health agencies on hospitals, nursing homes, and
home health agencies in the mid-Atlantic region and specifically, in Delaware. “In Delaware,
hospital-owned nursing homes reduced their Medicare utilization, and proprietary facilities
increased their utilization. One-third of the HHAs in Delaware withdrew from Medicare
19. Bryant, L. L., Floersch, N., Richard, A. A. and Schlenker, R. E. (2004) Measuring Healthcare
Outcomes to Improve Quality of Care Across Post-Acute Care Provider Settings. Abstract,
Journal of Nursing Care Quality, 19:368-376.
Summary: This abstract describes a study that reviews existing data sets used in the post-acute
setting and examines efforts to create measures for post-acute care and provides future
direction for research. The author of the article argues that in order to effectively measure the
impact of care on clinical outcomes, “a valid, reliable manner that allows for comparisons to
reference or benchmarking data” needs to be developed.
20. Budetti, P. P., Shortell, S. M., Waters, T. M., Alexander, J. A., Burns, L. R., Gilles, R. R., and
Zuckerman, H. (2002) Physician and Health System Integration. Health Affairs, 21: 203-210.