Guest Columns

Proposed cardiac bundles open new opportunities

Virginia Feldman, M.D., President & CEO of Nexus Health Resources
Virginia Feldman, M.D., President & CEO of Nexus Health Resources

The recently proposed mandatory bundled payment program for heart attacks and bypass surgeries is the latest push by CMS to extend the “at risk” period from a 30-day to 90-day period. This extended risk period provides post-acute providers with a new opportunity to distinguish themselves to hospitals by offering solutions for mitigating the total patient spend over 90-days.

Specifically, hospitals are likely to look for post-acute partners that can provide services to address the slow recovery process associated with heart attack and bypass surgery patients.

Let's take the heart attack recovery process as an example. First, consider that the average hospital length of stay for a heart attack is approximately 5 days. Next, consider that the “target” SNF LOS of conveners and managed care groups is approximately 15 days. This leaves a 70-day period when the patient is “at-risk” while living outside of an institutional care setting. Research indicates that this new timeline exposes hospitals to costly events that can occur well after the first 30 days. For example, one study of 561,926 heart attack diagnosis found that the daily risks of first readmission to hospital does not plateau until seven weeks after hospitalization.




As hospitals begin to scramble to address this new exposure, post-acute providers have an opportunity to distinguish themselves as viable partners for heart attack and bypass referrals by expanding their discharge process to include some key transitional care processes.

Targeting patients with the highest risk of a future heart failure – Every year in the United States, 210,000 heart attacks happen in patients who have already had a heart attack. LTC facilities that provide additional transitional care services with the highest risk groups can help to reduce total patient spend with a second heart attack in an efficient manner. For example, for women who've already suffered a heart attack, diabetes doubles the risk for a second heart attack and increases the risk for heart failure. This patient subset would likely require additional services as heart failure or shock was the most common reason for a 30-day readmission following admission for a heart attack.

Expanded appointment scheduling – Many skilled nursing providers offer transitional care services that include assisting with scheduling an initial follow-up appointment with the patient and their primary care physician. With heart attack patients, skilled providers can provide tremendous value by scheduling the initial postoperative visit, as well as regular check-ups with the patient's heart specialist.

Strategic follow-ups to keep patients vigilant – As every clinician knows, all patients are unique as each one recovers at different rates. However, in general, patients should be gradually increasing their level of activity in the weeks following a heart attack and stay vigilant to deteriorations in their health. Follow-up calls by the LTC care team to these patients can be effective intervention to reduce the risk adverse outcomes during the approximately 70-days that the patient is living outside institutional care.

Whether these new proposed bundles begin July 1, 2017 or not, hospitals can't afford to risk being unprepared for these new “at-risk” challenges and the first skilled nursing providers to offer assistance will likely get their attention.

Virginia Feldman, MD is the CEO of Nexus Health Resources. Nexus Health Resources offers software and services to skilled nursing facilities, hospitals, and other providers to create a seamless, coordinated transitional care system that provides patient families and caregivers the resources to keep patients healthy at home.


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