Implementing Health Reform: Medicare experiments with bundled payments

Dr. Clough is board certified in internal medicine and serves in the Patient Care Models Group at the Center for Medicare & Medicaid Innovation.

Bundled payments in gastroenterology: Time for a colonoscopy bundle?

Joel Brill, M.D., AGAF, FASGE, FACG, CHCQM, and Rajeev Jain, M.D. commented:

In 2012 the American Gastroenterological Association 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 bundle has three components:

• Preprocedure period: includes physician/staff consultation, and bowel preparation instructions.

• Procedure: includes professional and technical fees for colonoscopy, sedation/anesthesia, facility, and pathology.

• Postprocedure period: includes postprocedure communication with patient, and repeat procedures if postcolonoscopy bleeding occurs or poor bowel preparation/inability to intubate cecum requires repeat procedures.

The workgroup is specifically not developing a recommended payment for a colonoscopy bundle; rather, the goal of the project is to provide physicians with a framework 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.

A full version of this article will appear in the April edition of Practice Quarterly.