Home' The Source : Second Quarter 2017 Contents In 2013, the CMS launched the Bundled
Payment for Care Improvement (BPCI) ini-
tiative that included four voluntary bundled
payment models for 48 di erent conditions.
As of April 2016, there were 1,522 participants,
concentrated in two models. That's when the
CMS launched its first mandatory bundled payment
model---Comprehensive Care for Joint Replacement
(CJR)---specific to total hip, partial hip replacement,
and knee replacement surgeries with or without hip
fracture, which are being performed at approximately
800 hospitals. At the end of 2016, it finalized rules for
three new bundled payment models and one incentive-
based payment model:
• Acute Myocardial Infarction (AMI) Model
• Coronary Artery Bypass Graft (CABG) Model
• Surgical Hip and Femur Fracture Treatment
• Cardiac Rehabilitation (CR) Incentive Payment
Beginning Oct. 1, 2017, approximately 1,095 hospitals
will participate in the AMI model, 1,096 hospitals in
the CABG model, 865 hospitals in the SHFFT model,
and 1,320 hospitals in the CR Incentive Payment Model.
These mandatory bundles share many similarities, but
they also have some important di erences, as outlined
in the chart on page 34.
"We don't think providers are going to have much
trouble understanding CABG patient population," says
April Simon, vice president of clinical consulting and
analytics for HealthTrust. "We have been studying these
patients for a long time, and we generally know what
happens to these patients during their hospitalization
and for 30 days post-procedure. The additional 60 days
of follow-up is going to be new, but we don't see any
NAVIGATING THE UNKNOWN
But Simon does highlight the challenges in managing
the AMI model. "Many times providers don't know what
the next 90 days will hold," she says. "HealthTrust has
done some research to give our members an idea of what
those 90 days currently entail; however, this is new terri-
tory and the readmission rates in this patient population
is very high for both what appears to be planned and
The HealthTrust studies were presented at the
American College of Cardiology annual scientific meet-
ing. "Medicare Reimbursement Associated With AMI
With the proliferation of value-based payment models that
make reducing complications and preventing readmissions a
financial imperative, providers are wondering what's at stake for
their facilities and IDNs.
"Many providers know that complications and readmissions
impact their ability to be successful, but tracking this information
and analyzing it in a meaningful way can be di cult, says April
Simon, vice president of clinical consulting and analytics for
HealthTrust. "Focusing on process changes also requires time and
Simon has amassed a large body of scientific work that helps to
quantify the cost of various complications associated with coronary
artery bypass graft (CABG), percutaneous coronary intervention
(PCI), implantable cardioverter defibrillator (ICD), ablation, total
hip and knee replacement, and lumber spine fusion, among others.
Some of the biggest complications in terms of cost and
frequency include blood loss requiring transfusion, renal failure,
respiratory distress, infection and death. By focusing e orts on
reducing frequently occurring and expensive complications,
hospitals can reduce their overall costs.
"Savings will vary substantially, but we have worked with
large hospitals that have saved millions of dollars on the index
hospitalizations, alone" Simon says. "Reducing readmissions and
post-acute care days can increase those amounts significantly."
Another benefit is improved patient satisfaction scores.
"Everyone's happier, including the physician, when the intended
outcome occurs without the unintended consequence," she says.
No hospital is immune to surgical complications; however,
hospitals can put systems in place to minimize them. These
include a robust mortality and morbidity review to track and trend
their occurrence---and then protocols, algorithms and appropriate
provider coverage to address identified issues, Simon adds.
Once facilities have visualized and quantified the problem,
the next step is to engage the medical sta . "I've worked with
physicians for more than 30 years, and I'm still amazed at their
ability to rapidly analyze a situation and come up with solutions,"
she says. "Remember, physicians are trained to quickly assess
situations and act to correct. They tend to be very systematic in
their approach to ruling out options prior to acting. If you can get
them to participate in the process and give them solid data that
they trust, they will be very creative and come up with solutions."
To keep physicians involved, run e cient meetings and be willing
to brainstorm and negotiate implementation strategies. Progress
cannot be made without change, which won't occur without
medical sta being on board.
Second Quarter 2017 | The Source 31
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