Home' The Source : Second Quarter 2017 Contents Hospitalization and 90-Day Post-Discharge,"
found that a percutaneous coronary interven-
tion increases the cost to Medicare of an AMI
index hospitalization, but it is associated with
lower post-acute care cost. The study also
identified key comorbid conditions associ-
ated with higher total Medicare cost during
an AMI episode.
Another study completed by HealthTrust
and its physician advisors, "Understanding
Readmissions in Medicare Beneficiaries
During the 90-Day Follow-Up Period
Following an AMI Admission," found that
heart failure, cardiac surgery, sepsis and
respiratory illnesses are the four most com-
mon reasons for readmission, accounting
for more than 35 percent of all readmis-
sions. And, the following four conditions
during the index hospitalization increased
the likelihood of having a readmission
by more than 30 percent: end-stage renal
disease, not having a PCI during the in-
dex hospitalization, Type 1 diabetes and
In addition to CJR, many hospitals are
participating in the BPCI initiative that
ends in 2018. In September 2016, the CMS
published its second annual report detailing
early outcomes from the voluntary program.
According to the report, 11 clinical episode
groups show potential savings to Medicare,
including orthopedic surgery---likely due
to a shift among participants from more
expensive institutional post-acute care to less
expensive home health care---and cardiovas-
cular surgery---likely due to a reduction in
readmissions and complications.
SUCCEEDING AT BUNDLES
To be successful under any bundled pay-
ment model, hospitals need to set up the
right infrastructure that enables physician
alignment and leadership; the availability of
accurate, meaningful and actionable data; ev-
idence-based standardization of care; patient
engagement and navigation; care channel
communication; and internal cost optimiza-
tion, says Todd DeVree, director of bundled
payment solutions at HealthTrust. It's a
significant but necessary undertaking that
requires support and collaboration across
"It truly takes a redesign of the care model,"
Simon and DeVree are currently working
with several HealthTrust members to pre-
pare them for the latest bundled payment
initiatives. They collaborate on assembling
the team, analyzing data, identifying oppor-
tunities for improvement, implementing
the care redesign plan and providing feed-
back to keep the momentum going. After
implementation, HealthTrust can also help
track outcomes and recommend changes to
the approach based on results.
"This program is most successful when
we get administrators, nursing directors and
medical sta all singing o the same sheet of
music," Simon says. "If we help them set up
the right structure, they'll be able to solve the
next set of problems on their own."
The process is unique for each member,
but always starts with the same step---phy-
sician and administration alignment.
"You can identify areas of improvement
to redesign care, but if physicians aren't
involved then execution of the plan will
not be as successful," DeVree says.
By starting with physician and adminis-
trative alignment, facilities can work with
key stakeholders to establish shared objec-
tives and identify leaders of the initiative.
Gainsharing agreements are sometimes
used to incentivize, especially if physicians
are not employed by the hospital, but they
should never be the primary tool, DeVree says.
"HealthTrust recommends aligning
around clinical data, the patient experience,
and analysis of outcomes such as readmis-
sions and complications---not just implant
costs," he says. "If gainsharing is utilized,
it should serve to focus physician attention
on those areas." S
"This program is most successful when we get
administrators, nursing directors and medical sta all
singing o the same sheet of music. If we help them set
up the right structure, they'll be able to solve the next
set of problems on their own."
April Simon, vice president of clinical consulting and analytics for HealthTrust
32 The Source | Second Quarter 2017
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