The Michigan Value Collaborative

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

Tag: post-acute care (page 1 of 3)

Using Clinical Pillars to enhance value in a Joint Replacement Bundled Payment Program

Deby Evans

Deb Evans is the MVC Site Engagement Manager

An article published in the Journal of Arthroplasty in June 2017 discussed 5 clinical pillars that one hospital in New York identified for enhancing value in their joint replacement practices through the bundled payment program.

  1. Optimizing patient selection and comorbidities: The hospital identified common comorbidities within their Total Joint Arthroplasty (TJA) patient population. The most frequent were found to be musculoskeletal comorbidities, hypertension, hyperlipidemia, tobacco use and diabetes. Each of these comorbidities is associated with an increased risk for readmission. By incorporating the use of a readmission risk assessment tool (RRAT) into the Perioperative Orthopedic Surgical Home (POSH) initiative, the hospital identifies patients that are at high risk for readmission and delays surgery in favor of working to optimize the patient’s modifiable risk factors. By getting the patient in optimal condition for surgery, the risk of an unplanned readmission can be reduced, saving the hospital the associated costs.
  2. Optimizing care coordination, patient education, shared decision-making and patient expectations: Multiple studies have shown that splintered care pathways, unnecessary services and a lack of patient-centered care negatively impact clinical outcomes. Characteristics of programs that displayed improved patient outcomes were synchronized management among the patient’s care team and managing the expectations of the patient and family. The goal for this hospital was to institute a streamlined pathway for the duration of the episode of care that focused on collaborative decision making and standardized pathway criteria.
  3. Multimodal analgesia: An increased length of stay not only affects cost but also increases the risk of readmission. One of the factors known to influence length of stay is pain management. This facility reviewed their pain management protocol and made changes with the intention of decreasing opioid use while maintaining pain relief as well as facilitating early ambulation and rehabilitation and decreasing falls. These principles help to reduce length of stay by expediting discharge and decreasing the use of post-acute care facilities.
  4. Risk-stratified Venous Thromboembolic disease (VTED) prophylaxis: Use of an aggressive mode of VTED prophylaxis may be effective in preventing venous thrombosis, but has also shown to increase the risk of major complications. The institution performed a study to analyze their adapted risk-stratification algorithm with positive results. The use of this algorithm to identify which VTED prophylaxis trajectory was most appropriate helped the hospital optimize care and reduce costs.
  5. Minimize Post-acute care facility and resource utilization: Increased costs have been shown to be related to the use of post-acute care facilities and the associated resource utilization. In an effort to help control post-acute care costs, this institution worked on identifying selected post-acute care partners. Once identified the hospital and the partnering skilled nursing facility increased communication and collaboration through meetings and performance and resource utilization monitoring. By establishing these partnerships post-acute care length of stay was reduced with associated cost savings.

Through focusing on these five clinical pillars, this New York hospital was able to identify areas of improvement and subsequently implement initiatives targeted towards care and cost improvement. If your hospital is interested in identifying five clinical pillars of focus, the MVC Coordinating Center can help  identify common readmission diagnoses, along with post- acute care SNF utilization and length of stay information.

Moreover, the MVC Coordinating Center, in conjunction with MARCQI and MOPEN, is also holding workgroups on November 30th and December 7th to discuss pre- and post- surgical pain management. If you are interested in joining either of the workgroups, please register here.

Please contact Abeer Yassine at abeery@med.umich.edu or Deb Evans at debevans@med.umich.edu  for more information and if you have any questions.

McLaren- Lansing: Using Change as an Opportunity for Optimizing Palliative Care

Kim Hecksel

McLaren- Lansing Palliative Care nurses from left to right: Kim, RN, Paula, CNP and Carol, RN

Although the palliative care program at McLaren- Lansing has been around for about a decade, health care organizations are constantly changing and evolving to meet patient and family needs. The MVC Coordinating Center had the opportunity to speak to the team of case managers and nurses from McLaren- Lansing to hear about the different successes and barriers to palliative care at this facility. One distinct characteristic of this palliative care program is that patients and families are seen by and interact with consistent faces, rather than different clinicians, each time they visit. McLaren uses this consistency as leverage through transitions of care, especially at a time when clinician duties and health organizations are constantly changing.

The palliative care program at McLaren- Lansing also keeps up with the constant changes in health care by utilizing different online resources. One resource available to hospitals interested in palliative care programs is the Center to Advance Palliative Care (CAPC). CAPC offers a platform to help provide different health care organizations across the nation the tools and resources needed to advance palliative care programs in their respective institutions. For example, some CAPC resources help palliative care teams set up and develop a business plan for their respective palliative care programs. CAPC resources are helping guide the McLaren- Lansing team in creating a business model that illustrates the financial impact of a palliative care program on the health system. For more information on CAPC and the resources they can provide, visit www.capc.org.

The palliative care team also looks at the big picture of the care provided to patients and consequently putting together different pieces of information to ultimately develop a course of treatment that best meets the needs of the patients and the family involved. One of the barriers McLaren- Lansing has with their palliative care program is working with patients, family members and other health care providers on understanding the value of palliative care and what it really offers. When met with this resistance, the palliative care team works in different ways on learning about and discussing the care plan and goal setting to find the right format for communication and understanding a diverse patient population. For example, the palliative care team engages with physicians one-on-one and attends presentations on the benefits of palliative care to better understand and work with patients and their families about their diagnosis and individualized care plan. Taking advantage of different resources available, such as CAPC, and instilling a strong support system among the palliative care team and liaising teams are factors that aid in instituting a successful palliative care program.

If you are interested in learning more about the palliative care program at McLaren- Lansing, please feel free to reach out to Deby (debevans@med.umich.edu) or Abeer (abeery@med.umich.edu) for more information and contact.

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