I think bundled payments will hurt us quite a bit, but I guess it all depends who decides how the bundle is divided. If you assume it's the hospital getting the payment and making the decision, at a time when hospitals are already undervaluing our contribution (getting rid of subsidies, hiring AMCs for bottom-dollar, transitioning from MD model to CRNA models of care), the writing is really on the wall.
If the medical staff gets together to make the decisions, the outcome will depend on how much our physician colleagues respect our contribution. Ask yourself, "Do other doctors think we're real doctors?" The answer will determine how bundling will affect us.
Some practices will or have gotten involved on the pain side or ICU side of things, as a sort of loss-leader to be involved in a larger portion of a patient's hospital experience in order to argue for a larger chunk of the bundle. Too soon to tell how successful this approach wil be.
