Approximately 2,440 hospitals will participate in the bundled payment program for cardiac care beginning in January 2018. Health systems around the country have identified essential steps for structuring cardiac bundle programs to optimize performance, according to a recent report from the Healthcare Financial Management Association.
Of the 2,440 hospitals that will participate, 1,120 in 98 markets will be held financially accountable for the cost and quality of all care for a 90-day episode of care for acute myocardial infarction (AMI) and coronary artery bypass graft (CABG). About 1,320 hospitals in 45 geographic areas will participate in a separate model for cardiac rehabilitation.
HFMA identified seven key elements for structuring cardiac payment bundles. We present the first four here. The remainder will be in next week’s newsletter/blog.
Establish clear and achievable goals: Providers should enter cardiac bundled payments with a clear purpose; for example to solve a clinical problem such a high readmission rate or lengths of stay. Neither of these can guarantee a particular financial outcome. If the provider wants a high financial return, bundled payment is probably not where the organization will find that return.
Focus on inpatient costs and reducing care variation: Cardiac bundles typically have much lower post-acute spending compared to joint replacement bundles. Hospitalization accounts for about half of all spending to treat AMI and about 75 percent to treat CABG. So providers should focus on understanding inpatient spending patterns, reducing costs and improving quality by reducing readmissions and unnecessary variations in care.
Let data be the guide: Providers should analyze where performance varies from a benchmark standard. This type analysis requires a “robust way” of measuring compliance with standards and best practices, along with an honest evaluation of the organization’s ability to build the infrastructure to accurately track data needed to understand the relationship between an activity and its outcome.
Focus on medication management and compliance: Providers should focus on whether physicians are prescribing the appropriate medications and that patients are complying with their medication regime. A good practice is to have physician’s assistants or nurse practitioners prepare patients before discharge. Patients who have undergone heart surgery get a phone call from a nurse to make sure they’re on track with their medications.
(Source: “How Providers Should Prepare for New Bundled Payments,” HFMA Leadership +, June 13, 2017)
In next week’s newsletter/blog, we will continue with three additional elements providers should consider when preparing for cardiac bundled payments.
Coming soon: the advanced Finance Course, Financial Risks & Strategic Implications of APMs, featuring Marian Jennings and Seth Edwards. In this course, Marian and Seth discuss the risks of participating in ACOs and bundled payments, and also the risks of not participating in these alternative payment models. They also cover the characteristics of organizations that have successfully implemented alternative payment models.
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