Doctors' uncertainty about bundling, (especially those in small groups) may seem puzzling, but there are complex issues surrounding the payment formula, Sanjay B. Saxena, MD, a partner with Booz & Co., based in Sacramento, and a proponent of the payment model, told me.
For one thing, bundles are difficult to put together. "Design is hard, especially getting the risk- and gain-sharing arrangements right," the survey report notes. "Implementation is no picnic either – with persuading physicians to deliver against the bundles, integrating data and running bundles alongside traditional fee-for-service approaches topping the list of challenges."
"You might say, 'why isn't physicians' support widespread?'" Saxena asked. "It seems like a good thing for everyone—higher quality at lower cost. It makes a lot of sense, right?" Despite that, many physicians are so bogged down with other matters—regulatory reform, electronic medical records, the viability of their practices—that they are just weighed down by the idea of a new payment formula, Saxena says.
Then physicians are told: 'we've got to figure out a new model, it's bundled payment, it's different," Saxena says. Physicians are asking: How are we going to deal with it?
And there are other complications. Some providers believe if they are involved in ACOs, there is no reason to undertake bundling. And vice versa. That's a mistake, a Booz official says. "They link together very well, bundles and an ACO," says Brett Spencer, MD, a principal with Booz based in Chicago and a member of the firm's health practice division. When physicians manage their procedures under bundling, that can produce savings for an ACO overall, he adds.