TABLE 3.

Innovative Programs Mandated in the Health Care Reform Legislation

National Pilot Program on Payment Bundling Large scale 5-year voluntary effort will test the bundling of Medicare payments into a single comprehensive fee for an episode of care. Fee covers all health care entities before (3 days), during, and after (30 days) hospitalization.

Hospital Readmission Reduction Program Penalizes hospitals with greater than expected readmission rates for Medicare patients treated for congestive health failure, myocardial infarction, or pneumonia. Beginning October 2012, Medicare payments will decrease by 1%, 2% in 2013, and 3% in 2014. Expands in later years list of conditions that can result in penalties.

Adapted from “Hospital Readmissions and the Affordable Care Act: Paying for Coordinated Quality Care,” by R. P. Kocher & E. Y. Adashi, 2011, Journal of the American Medical Association, 306 (16), pp. 1794–1795.