Throughout the US healthcare system, bundled payments are swiftly gaining ground. These programs reimburse providers based on expected costs for clinically defined episodes of care. Such government initiatives as the voluntary Bundled Payments for Care Improvement Initiative (BPCI) and the mandatory Comprehensive Care for Joint Replacement (CCJR) model are pushing hospitals to assume greater financial risk for care episodes – not only within the hospital, but in the care settings that follow.
Readying patients for hospital discharge
In bundled payment arrangements, hospitals are financially accountable for minimizing patients’ length of stay in the hospital and for ensuring quality outcomes when they leave. As a result, to avoid financial risk, hospitals must carefully track what happens in the 90-day post-acute care (PAC) period that is beyond their direct control.
“More than ever before, acute care providers need to make sure patients are well-prepared for their next care settings – determining patients’ physical readiness for discharge and carefully planning post-acute care to prevent the likelihood of a decline or hospital readmission,” says Heather Moore, Administrator of StoneGate Senior Living‘s Providence Park, a leading rehabilitation and skilled nursing facility in Tyler, Texas.
Tyler is one of 75 markets nationally mandated to participate in CCJR and also has several physician groups that are voluntarily a part of BPCI. “We’re finding that bundled payments are less and less the exception and more and more the rule,” Moore notes. “Delivering efficient episodes requires acute care and post-acute care providers to collaborate in ways unprecedented.”
Raising the bar for PAC provider performance
Bundled arrangements have intensified expectations not only for hospitals but also for PAC providers. “If we want to be part of our hospital partners’ preferred PAC networks, we need to consistently deliver quality outcomes and savings,” Moore says. “The standard for discharge after surgery used to be the ‘three-midnight rule,’ requiring patients to stay three nights at the hospital before qualifying for benefits at a skilled nursing facility. Now, hospitals participating in a bundled payment arrangement may discharge patients two days or even one day out from their hospital stay. That means we may be caring for patients who are more vulnerable to complications, and we need to be ever vigilant in our care plans – including following the care pathways the referring provider wants us to use to minimize the risk of patient rehospitalization.”
Realigning for success
Key to optimum outcomes in the bundled payment environment, Moore notes, is regular communication between the PAC provider and the referring provider. “At our facility, a transitional nurse is in continuous contact with whoever is responsible for managing the bundle for the hospital or physician group. Any time we experience a barrier that could extend a patient’s length of stay with us, from a clinical setback to a challenging family dynamic, we discuss it with our referring care partner and seek further direction.”
Essential to bundled payment success is not only collaboration among care facilities but also with the patient. Providence Park uses the Teach-back method for patient education, a way to confirm that providers are explaining information clearly by having patients “teach back” what they’ve learned from their caregivers. “This method helps ensure patient compliance with care pathways and accelerate recovery,” Moore says.
Referring patients to the best PAC setting
Bundled payment programs increase pressures on acute care providers to choose the most efficient, high-quality PAC providers for continued care coordination. Hospitals will need to gauge potential PAC partners on a host of key quality indicators, from readmission and adverse event rates to time-to-admit and patient satisfaction ratings.
One innovation for helping acute-care providers evaluate these criteria and assess patient options is a centralized referral system. For example, StoneGate Senior Living recently launched a Central Intake Center (CIC), providing a time-saving way for discharge planners to ensure seamless care as their patients transition from the hospital. Instead of making multiple calls to find the best care setting, hospitals can make one call to the Tyler-based CIC, Moore explains. There, a registered nurse (RN) certified case manager and a transitional care admissions director readily recommend the PAC setting most appropriate for the patient’s needs.
“The team thoroughly assesses each patient to ensure the best placement possible in the right care environment,” Moore says. “It’s a convenient way for hospitals to match patients to a PAC provider based on their individual needs and preferences, make sure the PAC facility has everything in place to receive the patient immediately, and increase the likelihood of success in each bundled payment program.”
Realizing the right results
To date, Providence Park has a track record of positive returns in managing bundled payments. According to Moore, the facility has realized more than $45,000 in savings over the past two quarters. Return to acute hospital rates are at or below the national average, at 15%. Customer service scores are high, at 4 of possible 5.
Ultimately, bundled payments are a huge step forward for the healthcare system, Moore says. “Working together, care teams can be good financial stewards by judiciously monitoring the bundle – closely following every detail, in every minute of every hour. This abiding attentiveness is always in the best interest of the patient.”
Improve your success in bundled payment programs. Call 903-269-2082 or 844.342.7209 to ensure a seamless patient placement in a post-acute care facility.