Benefits of bundled payments turn on whether they are voluntary or mandatory: GAO

CMS suspects Medicare could save money by adopting episode-based payment models. But according to a new report by the the Government Accountability Office, the outcome is highly dependent on the specific structure of those models. In particular, the results can change massively depending on whether the models were voluntary. GAO found (PDF) that mandatory bundles would give the Centers for Medicare & Medicaid Services more consistent results, because practices tend to only participate in the voluntary models when they know they can come out ahead. As a result, voluntary models tend to advantage physicians more than Medicare. "In general, stakeholders reported that voluntary models largely benefit providers. For example, these models tend to have more generous terms and providers can choose to participate in only those models where they are likely to be successful," GAO said. "On the other hand, mandatory models are more likely to give CMS generalizable evaluation results."