Tension is Key for Bundled Payments, Report Cards

Public "report cards" for physicians have the potential to save money through eliminating complacency, according to a report from NPR's Planet Money. The report profiles Akron, Ohio-based Summa Health's Summa Hospital, which is piloting a bundled payment system.

In the story, a consultant hired by the hospital confronts several cardiac surgeons over opportunities for cost savings and efficiency through on-time starts to surgeries and prudent selection of surgical materials.

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While the process seems effective — the consultant shows the surgeons their percentage of on-time starts and asks them to consider the causes of their personal statistic, and the surgeons eventually respond positively — the report captures the defensiveness and finger-pointing that may be somewhat inevitable in the early stages of the improvement process.

Public report cards, or at least sharing individual performance data among clinicians, appear to be necessary to successful implementation of bundled payments, which exist to repair the perverse incentives of fee-for-service care and reward better care quality.

According to the report, "tension is part of the point" of the bundled payment system, which functions through appealing to the innate competitive nature of clinicians in general.

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