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bundled payment

bndl_pmt_amt
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

A healthcare reimbursement model in which a single payment covers all services delivered by multiple providers across an entire episode of care — from initial service through post-acute recovery — replacing separate fee-for-service payments to each individual provider. Bundled payments create financial incentives for providers to coordinate care efficiently, eliminate unnecessary services, and reduce costly complications and readmissions because all providers share a fixed payment regardless of total services rendered. CMS Bundled Payments for Care Improvement initiatives have tested bundled payment models for joint replacement, cardiac care, and oncology episodes.

Providers who deliver care within the bundle price keep the difference as shared savings while those who exceed the target price owe the difference back to CMS. Healthcare data teams build bundled payment analytics that define episode boundaries, aggregate all service payments within each episode, compare episode costs against the bundle price, identify cost drivers within high-cost episodes, and calculate net financial performance by episode type and surgeon or facility.

Standard Abbreviation

bndl_pmt_amt

Category

quality

Production DDL — FACT_QUALITY_MEASURE

FACT_QUALITY_MEASURE.sql
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
    qlty_key        INTEGER        NOT NULL  -- surrogate key,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    plan_key        INTEGER        NOT NULL  -- FK to DIM_PLAN,
    meas_yr         SMALLINT                 -- measurement year,
    hedis_meas_cd   VARCHAR(20)              -- HEDIS measure code,
    denom_ind       CHAR(1)                  -- denominator eligible,
    numer_ind       CHAR(1)                  -- numerator met,
    excl_ind        CHAR(1)                  -- exclusion indicator,
    gap_open_ind    CHAR(1)                  -- care gap open,
    star_rtg_nbr    DECIMAL(3,1)             -- star rating,
    qlty_scr        DECIMAL(5,2)             -- quality score,
    perf_thrsh_pct  DECIMAL(5,2)             -- performance threshold,
    raf_scr         DECIMAL(10,3)            -- risk adjustment factor,
    outreach_cnt    SMALLINT                 -- outreach attempts,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →

Why This Term Matters

Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.

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