In our VitalBlog we frequently share our thoughts and opinions on healthcare-related topics.

Driving change through new payment models

Dr. Lester Wold wrote this on Tuesday, September 13, 2016

les-blogNew payment models are driving changes in the way health care is delivered in the United States. The Center for Medicare and Medicaid Services (CMS) has implemented a program to bundle payment across the acute and post-acute care settings for individuals receiving a total hip (THA) or total knee (TKA) arthroplasty.  In recent years, providers have utilized post-acute care settings for the rehabilitation of patients post TKA or THA.  Although care in these post-acute care setting is generally lower than in the hospital setting, the costs overall of services delivered in these setting has dramatically increased in recent years.  In 2008 it is estimated that nearly 40% of Medicare beneficiaries leaving the acute care setting have been transferred to a post-acute care facility.  This has contributed to the increasing cost of care provided to Medicare beneficiaries.

Not only are post-acute care settings being utilized more frequently, but there is concern about the coordination of care between the acute and post-acute care sites.  The concern about care coordination is underscored by the estimate that over 15% of Medicare beneficiaries discharge to a post-acute care facility return to the acute care hospital within 30 days. Although sticks in the form of reimbursement penalties for “30 day readmissions” have been tried, it seems clear that some other mechanism is needed to both address the care coordination and cost problems associated with the delivery of services across the acute and post-acute care continuum.

Comprehensive Care for Joint Replacement program

CMS has recently launched the Comprehensive Care for Joint Replacement program (CJR). This program will involve nearly 800 hospitals and includes a bundled payment for services delivered to Medicare beneficiaries getting a THA or TKA. The bundled payment includes services delivered in the 90 days from admission for the total joint arthroplasty.  As such, it will incentivize systems to have much closer coordination between all of the care providers to ensure that the appropriate care is delivered in an efficient way. This minimizes the use of services, particularly those that may be duplicated in the acute and post-acute care settings.

Care coordination between acute and post-acute care settings

Care coordination is often complicated due to issue of communication across multiple health IT platforms and/or electronic medical records. VitalHealth Software has extensive experience in such care coordination. We have facilitated the coordination of care for patients with chronic diseases between primary care providers and specialists, particularly in The Netherlands. In The Netherlands, primary care is delivered by Care Groups and the specialty care is delivered in the hospital setting. The care coordination required to support that system is very similar to the care coordination required between acute and post-acute care settings in the United States.

VitalHealth Software’s suite of solutions is therefore ideally suited to support the bundled payment approach that CMS is using in the CJR program and others that will likely follow from CMS and third party payers.  For more information about VitalHealth Softwares approach to care coordination and bundled payments please visit www.vitalhealthsoftware.com/CJR.

Les Wold
CMO

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