Payment

Unlike traditional fee-for-service medicine, under a bundled payment approach the surgeon, other doctors, the hospital, and possibly other health providers and facilities share one fee for a surgical procedure or for treating a condition.

The goal of bundled payment is to encourage health care providers to coordinate care in an effort to deliver care more efficiently and to improve quality and outcomes. Bundled payments are typically either related to a procedure or clinical episode of care, such as colon resection, or to a specific condition, such as colon cancer, over a defined period of time. For example, a colon resection episode of care bundle could include surgical preparation, diagnostic tests, anesthesiology, the surgical procedure, operating room fees, radiological examinations, laboratory tests, and other physician services. A colon cancer condition bundle could include the services that are part of the colon resection bundle with the addition of chemotherapy, rehabilitation, readmissions, and postacute care. Although in this example the costs of the surgical procedure and associated follow-up care are less than the costs of the entire episode of care for treating colon cancer, it is important for surgeons to know how their services fit into the overall structure of the bundle in order to understand how they can impact the efficiency of the care delivered and effectively negotiate the distribution of the bundled payment. In this way, surgeons have the capacity to be key leaders in the future of bundled payments for surgical care.