Posts Tagged ‘payment reform’

5 Reasons for Post-Acute Care to Participate in Bundled Payments

September 1st, 2015 by Patricia Donovan

Bundled payment participation put Brooks Rehabilitation on the forefront of healthcare payment reform.


Having completed more than 1,000 bundled episodes for total hip replacements, total knee replacements and hip fractures, Brooks Rehabilitation has achieved significant savings through Model 3 of the CMS Bundled Payments for Care Improvement (BPCI) Model 3. Here, Debbie Reber, MHS, OTR, vice president of clinical services for Brooks Rehabilitation, explains Brooks’ rationale for participating in episode-based payment models.

Why would post-acute care be responsible for bundled payments, as opposed to the acute care provider? When CMS’s original bundles came out, it looked as though they would all be driven by acute care providers. At the time that Brooks jumped in, there was not a lot of information on what our opportunity would be or how this model was going to look. To explain our rationale for jumping into bundled payments, Brooks decided it was going to participate in order to be on the forefront of learning more about payment reform. We wanted to look at how post-acute care providers could help make some of the healthcare policy changes related to the future of healthcare reimbursement.

Second, we also really wanted to serve as a catalyst for a business to begin working better as a system of care. With all of our different divisions and the way our care settings are spread over the various counties that we serve, sometimes it was difficult for us to work as a united, seamless system. We thought moving to bundled payments offered a great opportunity for us to work better as a system of care, improve our care transitions, and improve our continuum.

Third, the other huge opportunity with bundled payment is the chance to experiment with clinical redesign. We approached bundled payments as having a blank slate: we could redesign the care to look and feel however we wanted it to be. If we could do things all over again, what were the tasks or gaps or cracks in our clinical care that we could really improve upon?

Fourth, we knew we wanted to have a strong voice regarding future policy and payment reform changes. And finally, we wanted to show that, in addition to key providers, Brooks was sophisticated enough to take risk and play a primary role with that continuum of care.

Source: Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign

post-acute care bundled payments

Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign shares the inside details of Brooks’ Complete Care program and the resulting, significant savings Brooks achieved through CMS’s BPCI Model 3, which is limited to retrospective post-acute care (PAC) for select diagnosis-related groups (DRGs).

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Posted in Affordable Care Act, Bundled Payments, Care Coordination, Care Transitions, Healthcare Reform, Post-Acute Care, Reducing Readmissions, Transitions in Care | Comments Off on 5 Reasons for Post-Acute Care to Participate in Bundled Payments

How Bon Secours Gets Paid for Providing Value-Based Healthcare

February 13th, 2015 by Patricia Donovan

ACO

Bon Secours 'Good Health' ACO is one of the largest in CMS's Medicare Shared Savings Program (MSSP).

Bon Secours Medical Group isn’t waiting for CMS to fully transition Medicare to pay-for-performance reimbursement models to get paid for providing value-based healthcare.

Instead, the 600-provider medical group has aligned itself closely with healthcare payment reform, applying a broad mix of patient-centered team-based care, technology and retooled care delivery systems to maximize quality and clinical outcomes and reduce spend associated with its managed patients.

Highlights of Bon Secours’ patient-centered approach were presented by Jennifer Seiden, administrative director, population health, and Lu Bowman, population health market program manager, during the recent webinar, Positioning for Value-Based Reimbursement: Workforce Development for Transitional Care, Chronic Care Management, now available for on-demand replay.

“The HHS’s historic announcement [of Medicare’s value-based payment timeline] was a clear signal to the industry and to the market that we better align ourselves and set ourselves up for it,” noted Ms. Seiden.

As far back as 2009, the prescient medical group had several pay-for-performance programs in place; in 2015, Bon Secours Good Health accountable care organization (ACO) is one of the largest participants in CMS’s Medicare Shared Savings Program (MSSP).

Today, most Bon Secours tactics emanate from the principles of the patient-centered medical home (PCMH), she said, with a focus on taking a population-wide view and closely managing “below-the-waterline” patients, guiding them to the most appropriate care settings and following up on them post-discharge.

The multidisciplinary care team is so essential to this patient-centered approach Bon Secours has constructed a business case to justify the team, she added, using a “Back to Basics” ROI equation developed by Robert Fortini, vice president and chief clinical officer.

Lauding Fortini’s efforts, Seiden explained the motivation behind his formula. “We had to develop a return on investment equation for the care team, because if you’re an independent practice or even if you’re employed, you’ve got to justify the expense of that additional overhead. That labor is not cheap.”

Results, revenue and key metrics like the number of post-discharge office visits and readmissions are tracked via electronic dashboards and rolled into the ROI equation.

Other strategies, including integration of behavioral health, embedding of case managers (nurse navigators) and EMTs, the use of ambulatory registries to stratify high-risk patients and a foray into retail healthcare contribute to Bon Secours’ impressive results, like a readmission rate of 2.08 percent for patients heavily monitored and managed by nurse navigators.

Ms. Bowman then described Bon Secours’ cohesive Care Management Services, which are divided into chronic care management services and complex chronic care management services. Nurse navigators are already working with Medicare’s new Chronic Care Management codes, another stepping stone in the federal payor’s volume-to-value transition.

“Nurse navigators are already providing chronic care management to patients. It was the natural next step for us to utilize these care management codes. The education for our team was focused on meeting the criteria, documentation and making sure the patient is always aware of and included in the care plan, which is so important to patient-centered care,” concluded Ms. Bowman.

Listen to comments from Jennifer Seiden.

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Posted in Accountable Care Organizations, Care Coordination, Embedded Case Management, Hospital Readmissions, Patient Registry, Population Health Management, Value-Based Reimbursement | Comments Off on How Bon Secours Gets Paid for Providing Value-Based Healthcare

4 Factors Driving Resurgence in the Physician-Hospital Organization Model Today

October 10th, 2014 by Cheryl Miller

As healthcare organizations seek the infrastructure to respond to emerging payment models like accountable care organizations (ACOs), bundled payments, narrow networks and direct contracts, the physician-hospital organization (PHO) model is experiencing a resurgence nationwide.

But will it work this time? Four factors make the PHO attractive, says Travis Ansel, senior manager with the Healthcare Strategy Group, during Preparing for Value-Based Reimbursement Models: PHO Development for ACOs, Bundled Payments and Direct Contracting, a 45-minute webinar from the Healthcare Intelligence Network (HIN) now available for replay.

The first most immediate driver is independent physician alignment, says Mr. Ansel. While most markets are mature in terms of employment, there are still a number of markets where there are a significant number of independent physicians in key specialties. In these areas, the PHO model is more of an initial catchall type of alignment model, one that creates a loose tie between the hospital and the physicians in the market, and provides value to the physicians in terms of being protected as part of a larger group without having to become employed. One benefit for the hospitals is that they can align independent physicians en masse and create common incentives, instead of having to negotiate alignment models or arrangements with all independent physicians in their market.

The second driver is the increasing mutual accountability for quality and cost across providers. In the wake of transitioning payment models under payment and insurance reform, insurers and payors are trying to drive mutual accountability for patient costs to physicians and hospitals. The PHO is an appropriate response for those providers to work together to manage the cost of a population and of an episode of care in order to make sure everybody’s successful.

The third factor driving resurgence in PHO activity is the consolidation and distribution of resources that will allow providers to be successful in managing quality and cost. As healthcare reform and payment reform mature, information technology (IT) competencies, clinical competencies, care coordination practices, and exploring the patient-centered medical home (PCMH) concept are often unrealistic at the individual practice level. The PHO gives physicians and hospitals the platform to work on those care competencies together, build them in one place and then distribute them to PHO members — a “win-win for everybody,” Mr. Ansel says.

The final driver is the need for an effective framework for clinical integration. While there are already a number of clinically integrated organizations around the country, “For the bottom 90 percent of healthcare organizations in the country, clinical integration is still that thing that’s on our to-do list, but it always gets bumped to the back of the to-do list; because, we have more immediate needs, or more immediate strategic priorities,” Mr. Ansel says. Clinically integrated models are needed as a strategy to respond to payment reform, to allow joint contracts between physicians and hospitals, and to enable sharing of payments effectively, whether those are shared savings payments, bundled payments, etc. Adds Mr. Ansel:

“The PHO model provides a great initial step to building that clinically integrated network platform, and gives providers and the hospital a great model for working together to start building the competencies towards a clinically integrated network.”

Click here for an interview with Mr. Ansel.

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Posted in Accountable Care Organizations, Affordable Care Act, Bundled Payments, Care Coordination, Health IT, Healthcare Costs, Healthcare Quality Ratings, Physician-Hospital Organizations, Population Health Management, Post-Acute Care | Comments Off on 4 Factors Driving Resurgence in the Physician-Hospital Organization Model Today