High-quality care at a low cost is the goal of the Centers for Medicare and Medicaid Services’ newly proposed bundled payment model targeting cardiac care. If finalized, this mandatory model would take effect July 1, 2017 and affect hospitals in 98 randomly selected metropolitan statistical areas.
Why should hospital leaders care about this new bundle?
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Despite the fact that it takes an entire village of providers to coordinate care and keep costs down, only hospitals would bear 100 percent of the financial risk, said Dr. James P. Fee, vice president at clinical documentation improvement company Enjoin and hospitalist at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana.
Hospitals that work with physicians and other providers to deliver care for less than a quality-adjusted target price would be paid based on the savings achieved. Hospitals with costs that exceed this price would be required to repay Medicare, he explained. Obviously, teamwork and data analytics are key.
This isn’t CMS’ first foray into mandatory bundled payments. Its Comprehensive Care for Joint Replacement Model, which includes hip and knee replacements, took effect April 1. Nearly 800 hospitals in 67 metro areas are required to participate. With the cardiac model, though, even more hospitals will be included because of the additional 31 MSAs.
And it’s likely not CMS’ last bundled payment model either. By 2018, 50 percent of traditional Medicare payments will be tied to quality or value.
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“This is a continuation on the path of shifting toward value,” said Fee. “Whether or not you’re in the bundle, this is the way healthcare is going,” he added. “Get on the bandwagon now before you’re forced to do it.”
Fee provided these tips:
1. Take a team approach. Include physician champions, health information managers, clinical documentation improvement specialists and quality managers. Set goals to develop efficient care flow processes, reduce readmissions and mortality, build care management infrastructures and ensure smooth care transitions.
2. Reach out to physician practices. Ensure that physicians capture each patient’s chronic disease burden appropriately. Establish measures to ensure proper post-discharge care, including cardiac rehabilitation, for which CMS provides additional financial incentives. Consider expanding clinical documentation improvement efforts into the outpatient arena, said Fee.
Let physicians know that participation in the cardiac bundled payment model could help to exempt them from having to comply with the Merit-Based Incentive Payment System, said Fee. That’s because this new model potentially qualifies as an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
3. Perform pre-bill documentation reviews. Have physicians thoroughly documented each patient’s acute disease severity and risk of mortality? Doing so yields the highest potential target price, said Fee. He recommended focusing on diagnosis-related groups for acute myocardial infarction, coronary angioplasty and coronary artery bypass graft.
4. Analyze the cost of care delivery. It’s imperative for organizations to assess the appropriateness of care and associated clinical variations, said Fee. Tracking outcomes assists with standardizing the use of cost-effective stents for coronary angioplasty, for example. It may also help lower costs related to care coordination.
5. Focus on quality metrics. Hospitals will be paid the savings from providing care for less than the quality-adjusted target price only when they meet specific quality standards related to heart attacks and bypass surgery. Hospital leaders should familiarize themselves with these measures, each of which is triggered by the index admission, to ensure that the entire cohort is studied, said Fee.
Photo: Flickr user Louise Docker