Taking on the bundled payment care improvement program

The bundled payment for care improvement initiative is a value-based model being piloted by the CMS Centers for Medicare and Medicaid Innovation (CMMI) at a number of US health care organizations.  An important difference from past cost-cutting innovations is that patient outcomes are a significant part of the value equation as well.  This has been a wonderful incentive to clinicians everywhere who see patient care as the center of their work and the costs as secondary.  

There are four different BPCI models being piloted (see https://innovation.cms.gov/initiatives/bundled-payments/# for additional information).  Organizations may pilot up to 48 different bundles or patient populations based on DRG groupings.  Total Joint Arthroplasty (Hip & Knee) is the most common bundle piloted.  Clinical redesign performed by multidisciplinary teams across acute and post-acute care settings are critical to achieving costs savings and better patient outcomes.

Performance metrics are an important redesign aspect as we cannot improve what we can’t measure.  Various metrics are identified, tracked, analyzed, and communicated to the teams  – clinical, financial, operational/ process, and outcome metrics to name a few.  There is a lot of variety in the tools and methods used to track performance making it difficult to compare results from one organization to another and sometimes even within the same organization.

IT professionals are in a unique position to guide clinicians in their approach to metrics and demonstrating results of improved work processes.  One of the consistent issues we see within an EHR is information being captured in many different ways, using different units of measure, and often in a free-text format rather than in discrete data fields.  Trying to then generate reports and populate real-time performance dashboards are not possible.  The more we can educate our clinical colleagues to capture any necessary information in discreet data elements, the more successful the institution and the pilot will be.

When thinking through what metrics would be beneficial, keep in mind those actions that support best practice across the care continuum.  Bundle episodes are defined as the acute hospital stay plus either a 30, 60 or 90 day timeframe after a patient’s discharge.  If you break down the care phases into pre-admission (for elective procedures), inpatient hospital admission, and post-acute care, you’ll begin to see what metrics might be most helpful.  A few examples for a total joint replacement patient might be:

  1. Did the patient attend the pre-op education class?
  2. Was the patient up and dangling at the bedside while still in the PACU/Recovery Area?
  3. Did the nurse call the post-acute provider and provide a warm handoff in preparation for discharge?
  4. Did the patient start their physical therapy within 24 hours of discharge?

Although there is some uncertainly in the health care legislation, bundled payments are already demonstrating costs savings with same or better outcomes.  The initial pilot will be ending 9/30/18 and most expect a new bundled payment model to be announced during that same period of time.  Use your time wisely and do all you can to ensure your clinician’s and patient’s success in this exciting endeavor!

DISCLAIMER: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS.  The authors assume responsibility for the accuracy and completeness of the information contained in this document.