The Remedy Partners Way: Networks, People, and Episode Tools Help Patients Recover at Home, Avoid Rehospitalization
Remedy Partners’ 2017 National Innovation Collaborative:
The Year’s Largest Gathering of Professionals Dedicated to Bundled Payments
Remedy Partners November 13, 2017
This year’s largest gathering of bundled payment operators will convene at Remedy Partners’ Fourth Annual National Innovation Collaborative in Atlanta, GA on November 16 -17. The conference, open to Remedy Partners’ clients and collaborators, is expected to garner more than 350 attendees. It will balance presentations from industry thought leaders with those of professionals working in bundled payment programs on a daily basis.
Remedy in the News
Bundled Payment Report Illustrates Increased Demand for Home Health
Home Health Care News | November 2, 2017
Remedy Partners names EVP of commercial business lines: 3 things to know
Becker's Hospital Review | November 1, 2017
Three reasons your SNF should sign up for CMS's BPCI Advanced Program
McKnight's Long-Term Care News | November 1, 2017
Remedy Partners Announces that One Hundred Percent of its Hospital Partners Achieve Positive Net Payment Reconciliation Amount (NPRA) in Bundled Payment Initiative
Medicare’s voluntary BPCI program’s financial results reveal positive NPRA for 100 percent of Remedy Partners’ engaged hospitals and 81 percent of its partner clients
Two recent studies demonstrate that the number of elective procedures does not vary significantly in bundled payment programs when compared to controls. Wilson, de Brantes and Conway analyzed1 the Medicare Bundled Payments for Care Improvement initiative to determine if the volume of Lower Joint Replacement (LJR) procedures increased under the model. Their analysis was in response to an editorial3 in the Journal of the American Medical Association that raised questions about elective procedure volume and bundled payments in an accompanying JAMA study.2
Managing Episodic Length of Stay (ELOS) in skilled nursing facilities (SNFs) is an important strategy to reduce unnecessary costs and improve outcomes during a patient’s episode of care. It is well established that SNF length of stay varies widely between geographic regions and by payer type (fee for service vs. managed Medicare, for example). This variability is perpetuated by a lack of accessible, standardized information about expectations, performance, and outcomes. The SNF Episodic Length of Stay (ELOS) Guidelines seek to address this issue by offering clinical recommendations and data-driven targets for managing SNF length of stay at the bundle level.
Hospital-based specialists, generalists (e.g., hospitalists), and surgeons participating in bundled payment programs have tremendous influence over the quality and costs of patient care inside the four walls of the hospital. While many interventions also have effects after discharge, others have more limited post-acute impact. All things being equal, physicians should focus their in-hospital efforts on practices that have a positive effect on patients after they leave the hospital. For example, holding goals of care conversations, early mobilization, prompt discontinuation of urinary and central venous catheters, and asking discharge planners "Why not home?" are but a few of many practices that may improve healthcare value during the post-acute period. In the linked article, I describe how practices that represent 'thinking outside the DRG', or outside the inpatient stay, may improve patient care during recovery from a hospitalization.
In its 2014 report, Dying in America, the Institute of Medicine identified several areas for improvement in the care of those with life-limiting illness, including inadequate advance care planning and a lack of payment systems supporting high quality end of life care. Since then, we can point to two notable achievements in support the IOM report’s call for improvement: the proliferation of bundled payment programs and two E&M codes for advance care planning. I believe these developments will make it possible for more patients with serious illness to receive palliative care, as for the first time incentives are aligned between patients’ desires and how care is paid for.
Selecting the optimal next site of care (NSOC) after hospital discharge has emerged as a core skill for physicians in the era of value-based healthcare. The challenge is that few of us have received formal training in post acute care site selection. When I meet with physicians and discuss NSOC selection, they express a clear desire for guidance on discharge planning as they work with patients, caregivers and the healthcare team. Here is a framework to assist physicians in post acute care selection within the BPCI program.
There’s a lot for physicians to remember in the course of patient care. If your group is working as part of a bundled payment program, you may feel some uncertainty as to exactly how you can ensure your patients have a safe care transition and a successful recovery from their episode of care.
We know that, more than principal diagnosis and comorbidities, patients’ functional mobility determines their trajectory during recovery.1 When patients are hospitalized, we impose a state of immobility in order to treat their acute illness. What results is a state of compromised independence that is associated with functional decline, falls, increased length of stay, delirium, loss of ability to perform activities of daily living and loss of ambulatory ability.
The Society of Hospital Medicine recognizes 2016 as the Year of the Hospitalist, commemorating 20 years since the term hospitalist was coined and the Society of Hospital Medicine was formed. Bob Wachter and Lee Goldman sparked the latent hospitalist movement with an article titled ‘The emerging role of ‘hospitalists’ in the American Healthcare System’ in an August 1996 issue of The New England Journal of Medicine. Several weeks later, John Nelson and I, both practicing hospitalists, formed the Society of Hospital Medicine (then incorporated in 1997).
Bundled payment programs require effective care coordination encompassing the hospitalization and the post-discharge recovery period. Within this care coordination process, selecting the ‘next site of care’ after hospital discharge is a crucial element in the provision of high value patient care. Why? When looking at large data sets representing aggregate spending, the cost of post-acute care can rival that of the initial inpatient stay.(1) For many bundles, total 90-day episode spending for a patient discharged to a skilled nursing facility can be more than two times that of a patient discharged to home.(2)