The American Hospital Association and the Association of American Medical Colleges commissioned Dobson DaVanzo & Associates to look at bundled payments and provide analysis on different episode-based payment bundles that providers could expect.
The study looked at 16 MS-DRG families that represent a significant portion of Medicare’s fee-for-service payments. Dobson DaVanzo analysts looked at the data on each of the selected MS-DRG families from 2007 to 2009 for a 30-day fixed-length episode. Here are the average bundled payments hospitals and other providers would expect to get for those 16 groups, standardized to 2009 dollars.
Note: Episode payments factored in several variables, such as relative variability and whether conditions have clear, evidence-based practice guidelines. To learn more about the AHA/AAMC analysis on bundled payments, click here.
Major joint replacement / reattachment of lower extremity
Percent of Medicare episodes: 4.7 percent
Average episode payment: $19,631
Heart failure and shock
Percent of Medicare episodes: 4.7 percent
Average episode payment: $12,006
Simple pneumonia and pleurisy
Percent of Medicare episodes: 3.9 percent
Average episode payment: $10,381
Chronic obstructive pulmonary disease
Percent of Medicare episodes: 3.7 percent
Average episode payment: $9,382
Intracranial hemorrhage or cerebral infarction
Percent of Medicare episodes: 2.4 percent
Average episode payment: $16,681
Hip and femur procedures except major joint
Percent of Medicare episodes: 1.5 percent
Average episode payment: $24,432
Percutaneous cardiovascular procedure with drug-eluting stent
Percent of Medicare episodes: 1.3 percent
Average episode payment: $13,568
Coronary bypass with cardiac cath
Percent of Medicare episodes: 0.4 percent
Average episode payment: $39,646
Revision of hip or knee replacement
Percent of Medicare episodes: 0.4 percent
Average episode payment: $24,121
Cardiac valve and other major cardiothoracic procedures without cardiac cath
Percent of Medicare episodes: 0.3 percent
Average episode payment: $44,926
Coronary bypass without cardiac cath
Percent of Medicare episodes: 0.3 percent
Average episode payment: $29,534
Cardiac valve and other major cardiothoracic procedures with cardiac cath
Percent of Medicare episodes: 0.2 percent
Average episode payment: $58,075
Bilateral or multiple major joint procedures of lower extremity
Percent of Medicare episodes: 0.1 percent
Average episode payment: $30,281
Nonspecific cerebrovascular accident and precerebral occlusion without infarction
Percent of Medicare episodes: 0.1 percent
Average episode payment: $10,533
Acute ischemic stroke with use of thrombolytic agent
Percent of Medicare episodes: 0.1 percent
Average episode payment: $24,599
Coronary bypass with percutaneous transluminal coronary angioplasty
Percent of Medicare episodes: Less than 0.1 percent
Average episode payment: $50,720
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