OR Manager - January 2018 - 20

Where are you on the value-based care continuum?
Finances
ealthcare providers are straddling
a variety of payment
models while many regulatory
changes remain in flux under the Trump
Administration. Although the shift from
fee-for-service to value-based payment
began some years ago, not everyone
is on board. Opinions about bundled
payments also remain mixed, despite
reports of improved outcomes and cost
savings achieved with this model.
Regardless of payment model, the
ability to demonstrate quality of care is
a competitive advantage in any healthcare
facility.
H
" OR managers need to be prepared
to make changes in care plans quickly
and efficiently, " says Margo Wood,
DNP, ACNP-BC, FNP-BC, at UMass Memorial
Health Care in Worcester, Massachusetts.
Wood has been the clinical
coordinator and patient navigator of a
successful bundle for coronary artery
bypass graft surgery (CABG) for the past
couple of years.
Her experience, along with programs
at other facilities, offers a snapshot of
how these programs work and some
factors to consider when deciding
whether to implement them.
Value-based care
Under value-based care (VBC), the Centers
for Medicare & Medicaid Services
(CMS) reduces by 2% the base diagnosis-related
group payments for hospitals
paid under the Inpatient Prospective
Payment System and redistributes the
money based on performance.
The number of hospitals participating
in VBC dropped from 2,955 in 2017 to
2,808 in 2018. According to CMS, the
highest performing hospital in FY 2018
will receive a net increase in payments
of slightly more than 3%, and the lowest
performing hospital will see a net reduction
in payments of 1.65%. Slightly
more than half of participating hospitals
(57%) will receive bonuses in 2018.
Nonetheless, according to a 2017
survey of 980 physicians by Bain and
Company, a management consulting
20
OR Manager | January 2018
Bundled payments are tied to improved
outcomes but also some risk for providers.
firm in New York City, 73% of respondents
said they prefer fee-for-service
models.
" After years of experimentation, physicians
now want evidence that new
models for care management, reimbursement,
policy, and patient engagement
will actually improve clinical outcomes.
Without it, they see little reason
to alter the status quo and move toward
widespread adoption, " the report authors
said.
The survey found that physicians believe
fee for service is more expensive
than other models, with 48% saying it
increases patient costs and 14% saying
it decreases costs. Twenty-seven
percent believe pay for performance
increases costs, and 17% believe capitation
increases patient costs.
What might persuade them to move
toward VBC?
" Healthcare organizations on the
forefront of change are moving to reempower
physicians, recognizing their
importance in managing costs and supporting
the move toward value-based
care, " the authors wrote. For example,
survey responses showed more than
80% of surgeons and procurement officers
are collaborating on medical equipment
purchasing decisions.
Some industry leaders, meanwhile,
have jumped on the VBC bandwagon. In
May 2017, the Pacific Business Group
on Health (PBGH) and the ERISA (Employment
Retirement Income Security
Act of 1974) Industry Committee (ERIC)
launched the DRIVE Initiative to urge
government support for this patient care
model. These Fortune 500 companies
have proposed policies to help achieve
the DRIVE mission: Deliver Results, Innovation,
and Value for Everyone.
Among the group's policy recommendations:
*
An explicit timeline to incorporate
prospectively set payments for comprehensive
bundles (facility, professional,
and drugs) in all CMS episode-based
payment programs.
* Continued support for innovative
value-based models: The Centers for
Medicare and Medicaid Innovation
and the State Innovations Model
program should remain fully funded
and operational, and should partner
with other payers when possible.
Bundled payments
Jeffry Peters,
MBA
" Under bundled payments,
one price is established
for all physician,
facility, and postdischarge
services, "
says Jeffry Peters, MBA,
chief executive officer of
Surgical Directions, a
consulting firm in Chicago.
" Physician groups or hospitals
can serve as the 'bundler,' and by managing
care to achieve good clinical outcomes,
the bundler keeps the difference
between the agreed-upon bundled
payment and actual costs, " he explains.
Healthcare providers who participate
in bundled payment models have the
opportunity to make more money, but
they also take on the risk previously assumed
by payers, he notes.
BPCI initiative
The Bundled Payments for Care Improvement,
or BPCI, is a voluntary initiative
launched by CMS in 2013. Providers
can participate in four models of
care with defined episodes of care:
* Model 1. inpatient stay in the acute
care hospital
* Model 2. inpatient stay in an acute
care hospital plus the post-acute
care and all related services up to
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OR Manager - January 2018

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