The Bundled Payments for Care Improvement (BPCI) initiative by the Centers for Medicare & Medicaid Services (CMS) is placing a premium on creating a more integrated, accessible flow of data for patients’ episodic and post-acute care. Providers across the spectrum of care have an increased incentive to collaborate more effectively as patients move between specialties and settings. CMS believes that the models defined in the BPCI initiative may lead to higher quality and more coordinated care at a lower cost to Medicare.
Bundled payments initiatives, specifically those designed around payments for episodes of care such as acute myocardial infarction (AMI) and coronary artery bypass graft (CABG), should be of high focus for providers as patients frequently require multiple imaging and lab procedures, often have comorbidities, and require post-acute care. Indeed, since CMS has proposed a mandatory bundled payment for AMI and CABG, it behooves providers to build an infrastructure that helps care teams coordinate and engage patients more effectively while at the same time amalgamating data to garner insights on how to not only improve quality of care during hospitalization but also improving post-acute care management.
Bundles Are Sweeping Away Fee-For-Service
The CMS categorization of its prescription for Cardiovascular (CV) service lines as an “episode payment model” rather than a customized cardiac care program suggests that bundles will become common for disciplines across the health care landscape. That’s all the more reason for specialties like CV to become invested in the interoperability of service line data and care delivery solutions. Through data reporting and analytic software providers should look to drive compliance with standardized evidence-based clinical practices and implement ongoing quality adjustment initiatives.
Sophisticated data analytics can be applied to extract actionable intelligence for identifying appropriate testing, placing patients into care management programs, and cutting costs. Analytics tools should be customizable to adapt to changing bundled payment models and help improve care episodes that consume the most resources and require the biggest payments. It makes sense that the highest cost patients, such as cardiovascular patients with comorbidities, present the best quality improvement opportunities for cost reduction.
A large emphasis to date is on gaining insight into managing the frequency and highly volatile costs of some CV procedures. Software tools, such as the Episodic Cost Profiler from The Advisory Board Company, can help outline national average Medicare spending by condition and site of service— including subsequent admissions, post-acute care and outpatient services—and displays 30-, 60- and 90-day post-admission episodic costs for various CV conditions and procedures. This knowledge can help providers formulate strategies for bundled payments success.
Data has shown that index admissions account for about 70% of CABG episodic costs, more than any other factor. Therefore, a bundling program that addresses CABG must stress cost reduction during initial hospitalization. However, readmissions and post-acute care comprise more than half of total AMI episodic care. The bundling strategy here would involve coordination with post-acute care providers to cut costs and intensifying efforts to prevent readmissions.
Adopt Change Now
The time for a provider to adapt isn’t when a bundled payment system is operational, it’s before the system is put in place. Now is the time for providers to determine the true cost of care and where resources are being wasted. Without a process that can report meaningful data from all its information touch points, it’s almost impossible for the hospital to perform an accurate cost analysis and calculate a sensible bundled price.
While having all the answers is nearly impossible setting up an infrastructure of interoperable solutions for care providers throughout the care continuum is an achievable goal. A single data hub of cardiovascular imaging and procedural data provided through a complete CVIS is integral for organizations hoping to achieve the efficiency in care and data collection needed to support bundle payments models. A complete CVIS solution can give providers access to the wealth of data collected during CV procedures and help them evaluate where there’s room for performance improvement. It must enable bundled payment participants to quickly analyze data and transmit information to physicians and post-acute care partners. And, it should yield data insights that help those providers determine which post-acute programs and facilities will provide the most benefit to discharged CV patients. With this inevitable transformation, it is important to build from the ground up and help ensure care is coordinated efficiently throughout the care continuum to achieve the most from bundled payment models.