Bundled payment systems have been with us a long while and maybe it’s time to tweak them, according to an opinion piece in JAMA. The authors argue that bundled payments can be even more cost-effective if their durations are lengthened, if some of the bundled services can be performed outside a hospital, and if they can be integrated with ACOs. Bundled payment systems pay providers for an episode of care based on how well they keep costs in check relative to benchmarks based on how much was spent in the past. The authors—Amol S. Navathe, MD, Zirui Song, MD, and Ezekiel J. Emanuel, MD—say that the current structure of bundled payment systems limit their effectiveness. Emanuel, who is now on the faculty of the University of Pennsylvania, was a health official in the Obama administration and had a hand in shaping the ACA. Bundled payments have retained the fee-for-service incentive to do more, especially for conditions without well-defined criteria for intervention, they wrote in JAMA. Another trouble spot: an unintended incentive to select for healthier patients and potentially increasing low-value care that offsets efficiency savings. Read more at Managed Care.