Tyler R. Grenda

Quiz Ref ID There is growing enthusiasm for reducing hospital costs through payment reform. One payment innovation that has gained traction is bundled payments, wherein health care providers receive a single fixed payment for all services (eg, hospital, physician, and postacute care) delivered surrounding an episode of care. Specifically, the Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement Initiative has expanded this program to 48 episodes of care that health care providers, such as hospitals and physicians, may elect to have bundled.¹ Most existing programs for common high-risk surgical procedures, such as cardiac and orthopedic surgery, have already been implemented.^1,2 Bariatric surgery, another common procedure, has been proposed as a potential candidate for inclusion in the next iteration of these programs.

Major resections for thoracic malignant neoplasms are associated with considerable risk for morbidity and mortality. Despite improvements in overall mortality rates, significant differences in perioperative outcomes exist across hospitals that perform lung cancer resection.¹ While the opportunity for quality improvement is clear, the optimal approach to achieve this goal is uncertain because the mechanisms underlying high morbidity and mortality rates have not been well defined.^2,3 There is a significant knowledge gap regarding what aspects of health care are most likely to improve outcomes through quality improvement initiatives.