Table 2.
Applications of Cardiology-Relevant Procedure Bundles From Public and Private Payers
| Characteristic | Medicare Acute Care Episode |
Cleveland Clinic and Boeing/Lowe’s/Walmart |
Integrated Healthcare Association |
Medicare Bundled Payments for Care Improvement |
|---|---|---|---|---|
| Procedure | Valve surgery | Valve surgery | Cardiac catheterization | PCI, pacemaker, ICD, valve surgery, CABG |
| Dates | Demonstration conducted from 2009–2012 | Partnerships with Cleveland Clinic established in 2010 (Lowe’s) and 2012 (Boeing and Walmart) | Pilot launched in 2012 | Program announced first participants in January 2013 and began in April 2013 |
| Patient cohort | Medicare beneficiaries | Covered Boeing, Lowe’s, or Walmart employees | Aetna, Blue Shield of California, and CIGNA PPO beneficiaries | Medicare beneficiaries |
| Duration | 90 d after discharge | Variable duration | 30 d after procedure | Variable duration: 30, 60, or 90 d after discharge |
| Services covered | All related Medicare Part A and Part B services, including any readmissions | All services and medications related to surgery, including medically necessary services delivered in Cleveland after discharge, plus travel and lodging for the employee and a relative | All related facility charges, imaging services, and professional fees, including those due to complications | Clinicians choose 1 of 4 options, which determine the scope and duration of the bundle. These types include (1) hospital stay, (2) hospital stay and postacute care, (3) postacute care only, or (4) hospital stay paid prospectively |
| Payment | Prospective payment with both gainsharing and downside risk | Prospective payment with both gainsharing and downside risk | Prospective payment with both gainsharing and downside risk | Retrospective payment in models 1, 2, and 3. Prospective payment in model 4. Both nonrisk-bearing (gainsharing only) and risk bearing (gain sharing and downside risk) options are possible for all models |
Abbreviations: CABG, coronary artery by pass grafting; ICD, implantable cardioverter defibrillator; PCI, percutaneous coronary intervention; PPO, preferred provider organization.