3 Reasons Providers Need to Manage the Entire Episode of Care

Preparing for the CMS Comprehensive Care for Joint Replacement Project

The most important takeaway from the latest CMS effort to rein in costs, achieve positive patient outcomes and lower hospital readmission rates and complication rates is that hospitals must now manage the entire episode of care.

CMS’s Comprehensive Care for Joint Replacement (CCJR) bundled-payment program mandates that 750 U.S. hospitals take responsibility for the care quality and total cost of hip and knee replacements, from surgery out through 90 days of rehabilitation and recovery. But the writing is on the wall for all hospitals, health systems and providers: Engaging patients throughout the care continuum—before, during and after surgery—will improve outcomes, decrease readmissions, earn CMS incentive payments and avoid penalties.

Are you prepared?

CMS’ quick and far-reaching enforcement of CCJR—scheduled to begin Jan. 1, 2016, at hospitals with widely disparate joint replacement costs in 75 geographical areas—should not surprise anyone. The agency has been paving the way toward value-based care since 2010. Bundled payment programs like this one will only become more ubiquitous in the coming years.

And the stakes are high. CCJR hospitals that meet CMS’s cost and quality of care measures over an entire episode of patient care will receive a higher reimbursement; those that don’t will have to repay some of that reimbursement.

But hospitals can succeed in CCJR and other future incentive programs when they manage the entire episode of care—patient expectations, readmissions, complications, costs and satisfaction. Here’s why:

1. When providers set expectations early, patient have better outcomes. 

The connection between patient-provider communication and patient outcomes is widely documented. Achieving positive outcomes and avoiding complications starts long before the patient enters the hospital.

In other words, if you want to improve outcomes and hospital revenue at the end of the care continuum, start educating patients before they walk in the hospital door.

2. Improving patient satisfaction counts, too—and it happens over time.

All hospitals are thinking about how to improve HCAHPS scores; CMS is, too. But improving patient satisfaction isn’t limited to the short amount of time a patient spends in the hospital.

In a 90-day post-op survey of patients who received digital education about their hospital stay at Mission Health in Asheville, North Carolina:

• 92% felt a stronger sense of connection to their hospital
• 82% were more likely to recommend the hospital because of the patient education systems

Imagine how these patients could improve HCAHPS scores for your hospital!

3. You can control unnecessary readmissions and post-acute care costs.

Educating and engaging with your patients boosts their understanding, confidence and even their outcomes. That, in turn, can reduce the average length of stay, readmissions and the number of patients discharged to post-acute facilities.

In a study of hip replacement surgery patients enrolled in patient education systems at Parkview Medical Center in Pueblo, Colorado, the hospital reduced the average length of stay by 17%, cut its average daily care cost by $2,000 and was able to treat an additional 30 surgical patients per year.

Research continues to find in-home rehab after knee or hip replacement surgery to be not only more cost-effective, but also equal in outcome and satisfaction as compared to rehab at an inpatient facility.

Indeed, educating patients about going home after joint surgery when it’s appropriate saves CMS and your hospital a lot under the CCJR program.

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CMS is not going away. To survive in the new healthcare world, hospitals must focus on engaging patients, not just when they walk in the door, but throughout their episode of care. Doing it right creates a win-in for everyone: happy, healthier patients and hospitals rewarded with reimbursements from CMS!

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