It’s important to admit one’s limitations, so I will admit to not knowing a great deal about the details of CMS’s bundled payment initiative or how to judge them. At 30,000 feet, sure, I can comment. Down to the nanometer, I’d have to do more work than I’ve had time for.
Vince Kuraitis has some thoughts on the matter. I can’t evaluate them either, but they’re more than I could do.
On one hand, CMS is encouraging creative and flexible proposals. This invites entrepreneurial thinking along the lines of geographic cherry picking, carve-out delivery approaches, and tight focus on niche diseases/conditions. […]
On the other hand, CMS expects applicants to collaborate with local care providers, particularly physicians. Such collaboration will create tension for applicants thinking along the lines of geographic cherry picking, carve-out delivery approaches, and tight focus on niche diseases/conditions. I foresee the potential for unintended consequences and fragmentation of care delivery.
I’m not following how the local collaborations are at odds with cherry picking. If they are, isn’t that good? However, if they lead to fragmentation, sure, that’s bad. To me this is a bundle of confusion. I’d appreciate readers’ thoughts in this area.