With COVID, would expect greater shift to Medicaid and some increased bad debt (patients not being able to pay co-pays/co-insurance). With 2 sided risk APMs (single bundle amount, no adjustments even if your costs are above or below actual amount in FFS environment), the devil would be in the details. Most bundles I've been a part of with commercial insurers have NOT been favorably constructed initially and have required a lot of work/pushback from me/my team and walking away from the deal multiple times. Some of these bundles have pegged your practice's bundle reimbursement to your own practice's historical costs, and rarely have allowed for a meaningful blending with say national payment rates or hospital rates. Over time, such a bundle would continue to erode margins. One theoretical benefit with bundles would be gold carding so no prior auths needed, but that hasn't always been agreed upon by payers, or no claims submissions (again, payers still want to see the FFS claims despite paying a bundle). It would be interesting to hear about others' commercial APM experiences.
