Readers may recall this notion arose largely in response to the problem of an average 20% readmission rate for Medicare beneficiaries who have been discharged from a hospital. Since hospitals can financially benefit from those readmissions, the concept of ‘bundling’ was invented. The good news is that bundling pays for a hospitalization and for all the necessary post-discharge care for a period of time (for example, 30, 45 or even 60 days). The bad news is that the bundling doesn’t pay for a readmission if that becomes necessary during that same period of time. Fans of bundled payments like it because the up-front extra payment should incent hospitals to dedicate resources to helping reduce avoidable readmissions. That's why bundling is one ingredient in the Democratic health reform proposals.
6. Bad behavior: This wasn’t brought up by the panelists, but the DMCB wonders if hospitals could end up with a financial incentive to deny inpatient care for patients that genuinely need to be readmitted to the hospital. After all, bundling sure looks like a form of capitation and we know how the physicians responded when they were forced to accept bad incentives. Could a hospital send someone home from the ER with advice to take two aspirins and call in the morning?
The DMCB also notes that much of the downsides described above can be amply mitigated by population-based care management. In fact, any literature search on post-discharge care coordination is likely to yield multiple articles that include the term 'disease management.' The DMCB says why not? Once again, non-physician professionals to the rescue with remote or in-person tailored interventions that can help persons and their family become experts in self-care. 'Nuff said.