The Unintended Effects of Bundled Payments on Health Disparities

Participants:
Mary O'Connor, M.D., & Bill Finerfrock

Summary:
An orthopedic surgeon's perspective on health disparities. Dr Mary O’Connor believes that new outcomes-based payment models such as bundled payments are exacerbating health disparities by ignoring the huge variance in circumstances for patients, and forcing providers to exclude more complex patients. In the real world, patients are getting very different care because of their race, gender, location and economic means, and some patients are squeezed out of the system completely through a process of "cherry picking and lemon dropping". Health inequities are widening as a result. Is risk-adjustment - incorporating social determinants - part of the solution?