The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Month: July 2016

3 ways a discharge planning tool can help your hospital improve

Maya Peters is a Research Associate with the Michigan Value Collaborative.

Transitions of care out of the acute care hospital setting are a hot topic, and for good reason.  Ineffective care transitions can lead to undesirable outcomes for both the patient and the hospital, including avoidable readmissions1. As payment policy moves away from fee-for-service and toward episode-based payments, there will be a necessity for greater connectivity between acute-care hospitals and post-acute care providers.  With readmission payment penalties of up to 3%, Medicare’s Hospital Readmission Reduction Program (HRRP) is already putting additional pressure on hospitals to improve these transitions2.

Luckily, hospital discharge planning tools can help improve the transition from an acute-care hospital to home or another post-acute care setting.  These tools help assess patient demographic and clinical characteristics, risk of readmission, acute care needs and level of resource use3.  Here are three ways these tools can help improve your hospital’s care transitions:

  1. Appropriate post-acute care placement

Discharge planning tools can help ensure that a patient receives care in the correct setting.  By taking into account patient demographics, activities of daily living, medical/clinical needs, and basic functioning (mobility) status, these tools help therapists and discharge planners better allocate therapy resources to the appropriate patients.  They also help identify when post-acute care may be unnecessary, thereby avoiding excess cost.

  1. Management of the transition of care itself

Discharge planning tools can assist in a smooth transition of care out of an acute-care setting, by identifying high risk or more complex patients.  This lets providers know that a patient’s transition to the next care setting should be more highly managed.  Interventions that can help manage a transition include: in-depth discharge summaries and instructions, teach-back method training on potential complications and appropriate responses, post-discharge phone calls, and a PCP follow-up visit within 7 days.

  1. Readmission reduction

Discharge planning tools can help reduce readmissions by taking into account a patient’s current conditions and procedures, length of stay, discharge disposition, and any social issues.  This information can help a provider determine what a patient’s risk of readmission may be, and therefore decide on the right post-acute care and placement.  The right move here can reduce the risk of inappropriate care leading to a readmission.

Many of the discharge planning tools available for hospitals to use require little to no staff time for completion.  Rather, many can pull available health data from a patient’s electronic health record, and may require just a few additional fields.  If your hospital isn’t already using a discharge planning tool, maybe it’s time to look into your options!

For more information on this topic, as well as a more in-depth look at a number of discharge planning tools in use around the country, read this helpful AHA report.


Sources:

  1. https://www.jointcommission.org/assets/1/18/Hot_Topics_Transitions_of_Care.pdf
  2. https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Medicare-s-Hospital-Readmission-Reduction-Program-FAQ/
  3. http://www.aha.org/content/15/15dischargetools.pdf

Questions or comments? We’d love to hear from you!  You can comment on this article, or fill out the contact form at the bottom of the page.

Top 10 Takeaways from the National Bundled Payment Summit

Chad Ellimoottil

Dr. Chad Ellimoottil is a Clinical Lecturer and Postdoctoral Fellow at the University of Michigan.

Vinay Guduguntla

Vinay Guduguntla is a medical student at the University of Michigan and a Research Assistant with the MVC.

MVC had the opportunity to attend the 2016 National Bundled Payment Summit in Washington, DC. The annual Summit brings together individuals from academia, health systems, payers and industry to discuss the future of episode-based payment measures and bundled payments.  

 

Takeaway 1:  There are many unknowns. There are so many models out there, each with different guidelines and metrics. After listening to the Q&A sessions from CMS and large private payers, it is clear that bundling is a far from perfect science.

Takeaway 2: Addressing knowledge gaps in bundled payments is a priority. While we are in our second iteration of bundled payments, there is still much to consider regarding program development. A common topic was the level and appropriateness of data granularity (e.g. cancer staging). Specifically, the inclusion of patient-reported outcomes for quality measurement, incorporation of drug costs, and condition vs. procedure specific bundling were discussed. 

Takeaway 3: Start slowly. If you are a health system, do not be too disruptive when initiating a bundled payment program – one-sided risk is not that bad. It is nice to have initially as you work out the kinks of the model.   

Takeaway 4: Invest resources into care transformation that can scale. Future bundles are coming from both CMS and private payers, so it is important to have processes that are not tied to a specific reimbursement program (e.g., Comprehensive Care for Joint Replacement, Bundled Payments for Care Improvement). Many health systems and physician groups are planning for future bundles by developing bundles that are multi-state and multi-payer.

Takeaway 5: Care standardization is necessary for success. Consulting companies will spend hours with physicians understanding their practice patterns to reduce variation (e.g., who do physicians send to a SNF and why?).  In addition, health systems like Mount Sinai create clinical pathways that reflect best practices.

Takeaway 6: Physician engagement is key.  This message was echoed throughout the conference. When implementing a new bundle, make sure to start with a clinical department that is engaged.  Then, focus on building new workflows into current practice (i.e., use Epic). Change is not easy, though, and framing the situation is vital. At the Summit, Mount Sinai discussed using principles of behavioral economics to adjust physician behavior.  For example, people have “loss aversion”, or the strong tendency to prefer avoiding losses than acquiring gains, so it is better to highlight incentives as “lost money”. Unblinding data is also effective because it increases transparency and accountability.

Takeaway 7: Employer-led bundled payments is a rapidly growing area. Employers need to reduce healthcare costs, and are attracted to bundled payments. However, many employers lack the expertise to develop and implement bundled payments. For this reason, physician organizations (e.g., North Carolina Orthopedics) and institutions (e.g., Northwestern) rely on the payer or broker (e.g. Pacific Business Group on Health) to create a bundled payment programs. These programs have greater focus on consistent high quality service instead of dramatically lower costs. Overall, employers are taking a cautious “test the waters” strategy by trialing pilots of narrow networks rather than going all-in from the start. Walmart is arguably the best example of employer-led bundled payments.

Takeaway 8: Providers are approaching insurance companies with bundles.  CIGNA now has over 50 bundled payment arrangements in various states for various conditions. Blue Cross Blue Shield New Jersey (BCBSNJ) has reported the same.  These payers work closely with providers and other payers in the state to discuss the construction of the episode.

Takeaway 9: Pay attention to Arkansas state-wide bundled payment programs and Blue Cross Blue Shield New Jersey (BCBSNJ)[1].  Arkansas has state-wide, multi-payer mandatory bundled payments for multiple conditions.  As a result, Blue Cross of Arkansas has seen millions in savings. They have bundles for joint replacement, c-section, heart failure, and other conditions. BCBSNJ has showed similar success in this area, and has lots of experience with bundles. More information here on AR and NJ.

Takeaway 10: There are many companies in the bundled payment and episode cost analytic space. Venders are very willing to talk to hospitals about how their products can help administrators improve data collection.

[1] http://healthaffairs.org/blog/2014/06/02/bundled-payments-moving-from-pilots-to-programs/