CCJR makes us look at delivery of long-term care

Ravi Komatireddy, M.D.
Ravi Komatireddy, M.D.

Dealing with change in healthcare in many ways feels like being a passenger on plane flying through turbulence: You're not sure how worried you should be, people in the front are telling you it's going to be okay, and the only way you can get information is to look out the window next to you, which isn't very helpful. This is similar to what is happening in long-term care.

The first change is the emergence of the Patient-Centered Surgical Home (PCSH). This involves shifting the location of care primarily to the patient's home. Part of this involves better patient care strategies within the  preoperative, intraoperative, and inpatient setting. These are matched with better discharge planning designed to empower patients with the right medical knowledge, better technology for remote monitoring and self support,  and improved care coordination across providers. The goal is to enable successful recovery in the home environment without the complications associated with traditional healthcare settings.  

The second is value-based payment reform and bundled payments. Value-based payment aims to shift reimbursement to reward patient outcomes versus medical services rendered. Bundled payments are an effort to create a fixed target price for a DRG or group of DRGs that include a group medical services. This is mandatory for Medicare patients undergoing lower extremity total joint arthroplasty starting April 1, 2016 in 67 major MSAs through the CMS Complete Care Joint Replacement (CCJR) initiative. One fee will cover the surgery, hospital, and post acute care costs.

Keep costs low, and any difference between the target price and the joint surgery episode gets refunded to the providers who can choose how to slice the pie amongst themselves. Go over the target cost and the providers cut a check to CMS. These concepts are going to force us to rethink how to best long-term care is utilized, introduce new technologies that we're all going to have to get familiar with, and push for patients being discharged to the lowest acuity path as well

Here are 2 ways in which long term care needs to evolve so as to thrive with these coming changes:  

  1. Patients want to be home – the home is the most secure, and comfortable place for patients. This is where they want to be. Let's find a way to get them back to a place where they can maintain their privacy and control. Let's get better about risk stratifying our patients so we can get a better sense of who really needs expensive and lengthy skilled nursing stays and who can succeed at home with other services.
    Recent advances in using big data and advanced analytics solutions, such as IBM Watson and navihealth, are already putting their talents to better decision support around utilization of post acute care services. Get smart, partner with these initiatives and shift your criteria for long term care services to being based on patient outcomes and risk instead of payer reimbursement length.

  2. Embrace the digital future –  An entirely new category of medical tools use mobile and wireless health technologies to provide patients and providers with the right data at the right time to make the right clinical decisions. These include mobile apps such as Wellpepper, wearable physiologic monitors such as the Cova, and telemedicine/telerehab systems such as Reflexion Health's product Vera can exist in the home or with a patient on a mobile device.  
    Long-term care providers are uniquely positioned to be the critical bridge to introduce these technologies to patients, create efficiencies around their use within a brick and mortar setting by force multiplying their labor force. By training clinicians to become competent with these technologies there's a real opportunity for long term care providers to “own” digital and telemedicine care. The first to pioneer new business models and expertise in telehealth services could become preferred providers within a bundled payment setting.   

These will force a rethink on role and operations of long term care so that we can patients can recover successfully and comfortably. All change in healthcare involves turbulence. To thrive let's make sure we stop being passengers and instead put ourselves in the cockpit. From there we can see a bit further out the window and have access to the right tools and knowledge to safely and successfully navigate these challenges and keep our patients on their plan for better health.  

Ravi Komatireddy, M.D, and the co-founder and chief medical officer at Reflexion Health. Howard Weiss, M.D., the medical director at Brooks Rehab in Jacksonville, FL, one of the largest independent post-acute players in Florida. 

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