Bundled Payment Options

Maximize Rewards Using Innovative Payment Models

With health-care expenditures consuming larger and larger percentages of the federal budget, policymakers are exploring alternatives to fee-for-service payment (FFS). “Bundled payment” is an alternative payment model that rewards providers for identifying efficiency gains, effectively coordinating patient care and improving the quality of care provided. AGA is committed to educating gastroenterologists about alternative payment models and preparing you for success in possible new reimbursement environments.

AGA Bundled Payment for Colonoscopy

The AGA developed a bundled payment framework for colonoscopy performed for colorectal cancer screening or surveillance. Watch a webinar to learn more AGA’s bundled payment model and to hear one practice’s experience exploring bundled payment models for colonoscopy. View the slide presentation. Read a list of bundled payment terms to help guide you in preparing for and successfully implementing a bundled payment model for colonoscopy. 

In 2012, the AGA convened a physician workgroup to explore how bundled payments could be incorporated into a gastroenterology practice. The workgroup explored various services and procedures, and identified colonoscopy as an initial target for developing a bundled payment methodology that could be easily adopted by GI physicians and ambulatory surgery centers as they contract with health plans, marketplaces, employers and accountable care organizations.

The working group specifically did NOT develop a recommended payment for a colonoscopy bundle; rather the goal of the project was to provide physicians with a framework that they can use when negotiating with their local entities. If successful, this can be a starting point for GI practices to develop episode bundles for other cognitive and procedural service lines.

Read the article Bundled Payments in Gastroenterology: Time for a Colonoscopy Bundle?

What is a Bundled Payment?

“Bundled payment” is a method in which payments to health-care providers are related to the predetermined expected costs of a grouping, or “bundle,” of related health-care services. The intent of bundled payment systems is to decrease health-care spending while improving or maintaining the quality of care. While still a form of FFS, bundled payments aim to facilitate financial alignment and coordination among providers. Paying one lump sum for an episode of care incentivizes providers to be more prudent than they would under fee-for-service. Instead of being paid in piecemeal for each service provided — and being rewarded for the quantity of services billed — providers are rewarded for identifying efficiency gains, effectively coordinating patient care and improving the quality of care provided.

Read the article Bundled Payments: What You Need to Know and Why.