EP434: 5 Surprises About Bundled Payments, With Benjamin Schwartz, MD, MBA

Most people who listen to this show know enough about bundled payments to be dangerous — which is exactly why Stacey Richter asked Ben Schwartz, MD, MBA, an orthopedic surgeon still in full-time clinical practice, what actually surprises people once they get past the basics. They walk through the four flavors of bundles currently in play — CMS bundles like BPCI and CJR, commercial carrier bundles, direct employer bundles, and condition- or diagnosis-specific bundles — and dig into why a program built to reward efficiency ends up penalizing the clinical teams who get too good at it.

WHAT YOU'LL LEARN

✅ What distinguishes the four types of bundled payments — CMS bundles (BPCI, CJR), commercial carrier bundles, direct employer bundles, and condition- or diagnosis-specific bundles — and why most current bundles are built around a surgical intervention

✅ Why CMS's BPCI bundles are being sunsetted, and how a program designed to reward efficient clinical teams ends up penalizing them once the goalposts keep shifting

✅ What surprises even people who already know the bundled payments landscape reasonably well

✅ Why direct employer bundles for musculoskeletal care are drawing entrepreneurial orthopedic surgeons who want to contract straight with employers and cut out the middleman

✅ How bundled payments connect to Centers of Excellence strategy, and where the model is likely headed next

WHY THIS MATTERS

Bundled payments are one of the clearer on-ramps to value-based care, but the mechanics matter enormously: a CMS program that rewards efficiency in year one and penalizes that same efficiency in year three teaches clinical teams the wrong lesson, and a bundle built around a surgical intervention doesn't translate cleanly to condition-specific care. For plan sponsors, health systems, and clinicians alike, understanding which type of bundle is in play, who's setting the rules, and how those rules shift over time is the difference between a bundle that drives real value and one that just shuffles risk around.

MENTIONED IN THIS EPISODE

EP415 with Rob Andrews: Apple Podcasts | Spotify | Other Apps

EP346 with Peter Hayes: Apple Podcasts | Spotify | Other Apps

Encore! EP294 with Steve Schutzer, MD: Apple Podcasts | Spotify | Other Apps

EP331 with Al Lewis: Apple Podcasts | Spotify | Other Apps

Encore! EP372 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps

EP373 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

📺 Subscribe to our YouTube channel

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction.

06:07 Where are we in the development of the bundled payments space?

08:09 What are the four types of bundled payments?

09:52 How can bundled payments create perverse incentives?

11:04 What are the positives in bundled payments, and how can they help push us toward value-based care?

13:02 What is surprising about bundled payments?

18:50 EP415 with Rob Andrews.

27:03 How do Centers of Excellence connect back to bundled payments?

29:00 EP346 with Peter Hayes.

30:29 Encore! EP294 with Steve Schutzer, MD.

33:38 EP331 with Al Lewis.

33:43 Encore! EP372 and EP373 with Cora Opsahl.

37:13 What does Dr. Schwartz think the future is for bundled payments?