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How Orthopedics Practices Can Win in a Pay-for-Performance Paradigm with Concierge Services
How Orthopedics Practices Can Win in a Pay-for-Performance Paradigm with Concierge Services
It’s common knowledge that healthcare providers across the continuum are being forced to rethink their procedures, policies and care practices as the shift from volume to value continues. While other specialties are experiencing disruption as a result of the shift, orthopedic practices may be undergoing the most turbulence as they navigate and/or prepare for Bundled Payment Programs (BPPs) instituted by the Centers for Medicare & Medicaid Services (CMS) such as the Comprehensive Care for Joint Replacement Program (CCJR) and multiple iterations of the Bundled Payment for Care Improvement (BPCI) program.
In short, BPPs encourage partnering with lower acuity care venues to avoid rehospitalization. While results show the program does reduce rehospitalizations and overall costs, many orthopedic practices haven’t formalized their processes for ensuring success in a value-based bundled care environment. In the new paradigm, if orthopedic patients return to the hospital, orthopedic practices stand to lose a lot of money. With BPPs being relatively new, many orthopedic practices are still looking for the best ways to manage patients after their surgeries to ensure efficient and effective recoveries that avoid rehospitalizations.
Your Therapy Source (YTS) has a tested, hands-on solution designed specifically for orthopedic practices looking to maximize reimbursement from BPPs by keeping patients out of the hospital after surgery.
Throughout this paper we’ll delve deeper into:
•BPP overview and challenges •Challenges for orthopedic surgeons aiming to avoid patient hospitalizations after discharge •Solutions and pitfalls •YTS’s White Glove Concierge solution •White Glove Concierge Service results
Introduction
Overview of CMS’s Bundled Payment Program
Specific to Orthopedics
“Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2014, there were more than 400,000 procedures, costing more than $7 billion for the hospitalizations alone. Despite the high volume of these surgeries, quality and costs of care for these hip and knee replacement surgeries still vary greatly among providers.”
“For instance, the rate of complications like infections or implant failures after surgery can be more than three times higher at some facilities than others, increasing the chances that the patient may be readmitted to the hospital. And, the average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas.”
“The Comprehensive Care for Joint Replacement (CCJR) model aims to support better and more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements (also called lower extremity joint replacements or LEJR). This model tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery.” “The model began on April 1, 2016 and will run through December 31, 2020. As of February 1, 2018 approximately 465 IPPS hospitals in 67 different MSAs are participating in this CJR model.” (CMS, 2018)
Advanced BPCI begins in October of 2017 and the concept will expand across the country on a voluntary basis for physicians and hospitals.
Challenges to Orthopedic Practices
The shift from fee-for-service is causing disruption across the healthcare industry. While the transition to quality is positive in many aspects, it’s a change. With any change, comes struggle.
According to Randall Schultz, MD, Texas Orthopedics, Sports & Rehabilitation Associates (Austin), “Until recently orthopedic surgeons have been paid in fee-for-service models. In other words, the more surgeries you performed and the more patients you saw in the office, the more you were paid. Now we will be paid based upon the quality of care we provide and for the cost with which we are able to provide it. In the fee-for-service model, if I replaced your hip and then brought you back to surgery because your hip failed or your hip dislocated, I would be paid more than a surgeon who performed a single, perfectly done hip replacement.”
“In the old model, surgeons had no incentive to lower the costs of care they provided. They essentially had a blank check to use whichever implants and facilities they deemed fit. We have now realized that the home environment is actually the safer and more cost-effective environment for patients to recover.” (Dyrda & Wood, 2016)
“WE HAVE NOW REALIZED THAT THE HOME ENVIRONMENT IS ACTUALLY THE SAFER AND
MORE COST-EFFECTIVE ENVIRONMENT FOR PATIENTS
TO RECOVER.”
Pitfalls of Existing Solutions
While many surgeons like Schultz (quoted above) have realized the benefits of home-based care, especially its effectiveness in helping doctors prevent avoidable readmissions, there are barriers to effective care coordination that can undermine this effort.
To address those barriers and meet the needs of value-based-care driven payment models, orthopedic practices are primarily turning to one or a combination of three primary solutions. These solutions are often falling short.
1. Home Health Agency Partnerships. While many realize the benefits of home health care after surgery and its effectiveness in helping patients get better faster and avoid hospital readmission, the home health partner vetting process is often underdeveloped or flawed.
“Traditionally, home health partnerships are relationship based. While relationships are important, this relationship-driven selection method is often based on which home health sales representative is top-of-mind rather than which provides the best patient care. This lack of vetting is not because orthopedic practices don’t care about their patients, it’s because they’re busy focusing on getting their patients through surgery successfully — as they should be!” said YTS CEO and founder, Sheri Yarbray.
“The Home Health agencies that appear on your list of providers for patients need to be regularly monitored and measured by care quality. That takes time, industry understanding and ongoing communication. This continuous scrutinization doesn’t typically occur and it needs to so that the healthy engaged home health providers are acknowledged for their worth,” said YTS Navigator, Richard Genzel, PT.
“TRADITIONALLY, HOME HEALTH PARTNERSHIPS ARE RELATIONSHIP BASED. WHILE
RELATIONSHIPS ARE IMPORTANT, THIS
RELATIONSHIP-DRIVEN SELECTION METHOD IS
OFTEN BASED ON WHICH HOME HEALTH SALES
REPRESENTATIVE IS TOP-OF-MIND RATHER THAN WHICH
PROVIDES THE BEST PATIENT CARE.”
Pitfalls of Existing Solutions (Cont.)
2. Conveners. Conveners are entities that have popped up in response to BPPs. “Conveners are parent companies, health systems or other organizations that wish to take risk and partner with other groups. Conveners are responsible for risk of their own bundled payment patients and the bundled payment patients of their partners, regardless of where the patients receive care.” (Rappleye, 2016)
“Although conveners are an innovative approach to getting ahead in a bundled care paradigm, we’re seeing some unintended consequences,” said Yarbray. Oftentimes conveners are examining data points to manage patients. While those data points might ensure the best financial return, they don’t always ensure the best outcomes in the long run. Further, since conveners are going at risk and taking on financial burden, they may focus on the lowest cost option rather than the best option.”
3. ACOs. “[Accountable Care Organizations] ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both
in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.” (CMS, 2018)
“Again, working together to improve patient care is always a good thing, but in the case of ACOs, it could be better,” said Yarbray.
“Choice providers are in the vertical but how were they chosen and how and when are we measuring them? Further, maybe the goal is met and patients aren’t going back to hospital, but they’re staying in other silos of care too long which is costing more than it should and delaying recovery. We need to incorporate ongoing real-time monitoring, standards and heightened communication,” said Genzel.
“CHOICE PROVIDERS ARE IN THE VERTICAL BUT HOW
WERE THEY CHOSEN AND HOW AND WHEN ARE WE
MEASURING THEM?…”
To help orthopedic practices succeed amid bundles and the transition from volume to value, and address the pitfalls of existing solutions, YTS developed its
White Glove Concierge Service and corresponding HIPAA-secured app. It combines the best of what’s working in the various existing solutions and
enhances them with ongoing and real-time monitoring, tracking, reviewing and communication. It enables providers and patients to:
prepare, engage, connect and follow.
Your Therapy Source’s White Glove Concierge
Your Therapy Source’s White Glove Concierge Service for Orthopedic Practices (Cont.)
Prepare: Care begins as soon as a patient learns he or she requires surgery. At this point a patient is likely to receive calls from an orthopedic floor manager, a hospital lab technician, a home health agency scheduler and maybe a social worker — all trying to organize and plan their components of care preparation. This can be overwhelming to a patient and increase stress levels for everyone from the beginning. YTS will ensure all callers’ needs are addressed and the patient is informed without bombarding the patient.
Additionally, YTS will ensure the small details that are often missed but make a huge difference in recovery are addressed and managed before surgery. For instance, does the patient have the appropriate shower? What about the patient’s dog? How will he be cared for after surgery? YTS will leave no stone unturned in preparing a patient for surgery.
Engage: YTS will engage with the patient personally to talk with him or her about the process, concerns, expectations and more. YTS will serve as a dependable support resource throughout the patient’s care journey.
Connect: The connection portion is two-pronged. First, YTS connects the orthopedic practice with the best rehab facilities, home health agencies and therapists. YTS vets post-acute partners and works with those that are willing to commit to better processes, outcomes and partnerships. The vetting process is ongoing. YTS continually monitors and tracks each provider’s outcomes, commitment to quality and patient experience. Second, YTS connects patients to their post-acute providers so care transitions are seamless.
Follow: YTS follows up with the patient following surgery to ensure his needs are met, he’s doing well and the post-acute caregiver is on hand. YTS continues to follow the patient 30-days post-surgery. A summary and complete status updates are regularly sent to the patient’s physician.
*All of the communication interactions are logged in YTS’s White Glove application — giving patients, surgeons and post-acute providers a common source of real time information. Patient picture updates are included.
Your Therapy Source’s White Glove Concierge Service for Orthopedic Practices (Cont.)
“IT’S AMAZING TO SEE HOW CONSTANT COMMUNICATION ENABLED BY OUR PROGRAM AND APP
HELPS THE PATIENT GET BETTER FASTER,” SAID YARBRAY. “WE SEE IT TIME AND TIME AGAIN THAT WHEN A PATIENT IS ENGAGED AND FEELS SUPPORTED HE OR
SHE ACHIEVES BETTER OUTCOMES FASTER.”
“SIMPLY STATED, ONE OF THE GREATEST OPPORTUNITIES FOR INCREASING SAVINGS AND
EFFICIENCY — AND FOR IMPROVING OUTCOMES — IS TO PROVIDE PATIENTS DISCHARGED FROM AN
INSTITUTIONAL SETTING WITH CERTAIN FOLLOW-UP CARE. HEALTH SYSTEMS THAT HAVE IMPLEMENTED
EVEN THE MOST RUDIMENTARY TRANSITIONAL CARE MANAGEMENT PROGRAMS HAVE REALIZED IMPRESSIVE
RESULTS.” (PYA, 2014)
Your Therapy Source’s White Glove Concierge Service Results
Tracking 120 patients whose surgeon leveraged YTS’s White Glove Concierge service over the course of one year:
•Only four (4) patients experienced a readmission within 30 days of surgery. That’s a 3.3 percent readmissions rate. With the overall 30-day readmission rate across all orthopedics being 5.4 percent (US National Library of Medicine National Institutes of Health, 2015), that’s nearly a 39.9 percent decrease in readmission.
•Patients received an average of 9.5 post-acute care visits.
0
1.5
3
4.5
6
Readmission Rates
Overall orthopedic readmission rate %YTS white glove program readmission rate %
“I CAN’T BELIEVE MY SURGEON WENT TO SUCH LENGTHS TO CARE FOR ME. I’VE NEVER RECEIVED THIS TYPE OF SERVICE IN
HEALTHCARE. I CANNOT RECOMMEND THIS SURGEON HIGHLY ENOUGH.”
-- ORTHOPEDIC PATIENT CARED FOR WITH YTS’S WHITE GLOVE CONCIERGE SERVICE
“I AM AMAZED AT HOW ALIGNING WITH YTS HAS STREAMLINED OUR POST-ACUTE CARE PROCESS AND COMPLETELY ENHANCED PATIENT
AND PROVIDER COMMUNICATION AS WELL AS PATIENT SATISFACTION AND ENGAGEMENT. ADDITIONALLY, COMPLICATIONS
AND READMISSIONS ARE REDUCED THROUGH IMPROVED COMMUNICATION BY THE ORTHOPEDIC APP. IT IS REMARKABLE HOW SUCH A SIMPLE CHANGE IN WORKFLOW CAN MAXIMIZE EFFICIENCY,
REDUCE COST AND AT THE SAME TIME IMPROVE CARE.” — ORTHOPEDIC SURGEON AND YTS WHITE GLOVE USER, DR.
JEFFREY MOFFETT.
Works Cited
CMS. (2018, 05 03). CMS.gov. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/CMS. (2018, May 27). Comprehensive Care for Joint Replacement Model. Retrieved from CMS.gov: https://innovation.cms.gov/initiatives/cjrDyrda, L., & Wood, M. (2016, May 24). Retrieved from Becker's ACS Review: https://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/how-cjr-bundled-payments-will-impact-orthopedics-6-surgeons-weigh-in.htmlPYA. (2014, November). http://www.pyapc.com/. Retrieved from Pershing Yoakley & Associates: http://www.pyapc.com/resources/collateral/white-papers/TCM-whitepaper-PYA.pdfRappleye, E. (2016, May 13). Becker's Hospital CFO Report. Retrieved from https://www.beckershospitalreview.com/finance/who-what-when-why-how-everything-you-need-to-know-about-bpci.htmlUS National Library of Medicine National Institutes of Health. (2015, April 17). NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401733/
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