The days of hospitals’ monitoring patients only within their walls are numbered. Already, hundreds of hospitals across the country have taken on the responsibility for Medicare patient outcomes from the first day of hospital admission on through 90 days after discharge.
Currently limited to patients with a handful of conditions (hip or knee replacements, heart attacks, coronary bypasses, and hip and femur fractures), the bundled payments set a target price intended to cover all hospital costs, provider fees, post-acute care expenses, and home care costs during an episode of care.
“The new orthopedic and cardiac bundled payment programs reflect a new economic reality for hospitals, which traditionally had very little responsibility for post-acute care,” Modern Healthcare recently reported. “In many markets across the country, they now will be responsible for the financial and clinical outcomes of patients for nearly three months after discharge.
“It is precisely in these critical post-discharge months that health systems have the least control over patient choice or progress.”
Under the Comprehensive Care for Joint Replacement Model and the Cardiac Rehabilitation Incentive Payment Model, Medicare reimburses hospitals and other providers for the services provided. However, the total cost for a patient’s episode of care is then reconciled with the pre-set target price. Hospitals that exceed the target price are financially responsible for some of the difference.
“But if they meet or beat the target price and hit a quality threshold, they receive a bonus,” Modern Healthcare continues. “Both the bonus and penalty escalate over five years until it hits 20% of the difference.”
The latter of which could be problematic for some hospitals.
The Modern Healthcare article cites research from the consulting firm Avalere Health as warning that more than half of the hospitals participating in the Comprehensive Care for Joint Replacement Model could face a financial hit. For about 15% of hospitals in the mid-Atlantic region alone, a full half-million dollars could go toward penalties the second or third year into the knee and hip replacement program.
After patients leave hospital grounds, hospitals have much less influence on their outcomes. While hospitals are figuring ways to keep a better watch on patients’ care and progress after they transfer to home, there is still plenty of room for improvement.
Patient care navigators can help fill transitional gaps by monitoring and coordinating care. The field is growing rapidly, but it’s not a cure-all for all situations. According to Modern Healthcare, some facilities have a shortage of patient care navigators to help patients. Others do not, which in itself can cause problems.
“They have care navigators, but the patients suffer from multiple chronic conditions and may be being treated at multiple institutions,” the article explains. “Each may be deploying their own care navigators to manage their care.”
Even telehealth and monitoring patient progress remotely through smart devices has a long way to go, Modern Healthcare reports. A pair of high-quality, large clinical trials suggested telemonitoring failed to reduce hospital readmissions for patients with heart disease, Kumar Dharmarajan, MD, MBA, Yale School of Medicine, told the publication.
Problem is, we still don’t understand all the factors that cause patients to be readmitted.
Some new pilot projects are testing technologies like remote control pill bottles to monitor medication adherence, implanted devices to track vital signs, and smart phones that can transmit photos of wounds that may be infected, the article explains. Portals and apps are also being tested to see if enhanced communication between patients and providers could generate better understanding of necessary home care and steps toward healing.
As Medicare and potentially other payers shift from fee-for-service to pay-for-performance or value-based care, technologies that remotely and accurately track patient progress will be key to keeping outcomes and reimbursement at healthy levels.