Through its mandatory bundled payment programs for cardiac care and joint replacement, the Centers for Medicare & Medicaid Services aims to lower care costs, boost efficiency, and improve quality by making participating hospitals accountable for the care that beneficiaries receive.

While this puts the onus on hospitals to improve care delivery across different settings of care and provider organizations, it also represents an opportunity for post-acute and long-term care facilities to position themselves as valued partners in helping to achieve those new standards.

Gaining insights across the episode

CMS’s Comprehensive Care for Joint Replacement model is now mandatory for all hospitals in 67 metro regions or metropolitan statistical areas across the country. On April 1, 2016, CMS introduced a proposal to expand the model to include surgical hip and femur fracture treatments.

CMS also plans to launch episode payment models for cardiac care, specifically for Acute Myocardial Infarction and Coronary Artery Bypass Grafting, on July 1, 2017, for hospitals in 98 MSAs.

In each program, participating hospitals are held financially accountable for the quality and cost of care from admission through 90 days post-discharge. By design, this encourages hospitals to improve care coordination with providers outside the hospital at rehabilitation clinics, skilled nursing facilities (SNFs), and other long-term care facilities.

To facilitate this effort, CMS will give participating hospitals a full set of utilization and payment data for care received during the episode. Accordingly, hospitals will gain a clear view into the performance of post-acute and long-term care facilities that contribute to overall care cost and quality.

Eye on long-term care facilities

While the direct pressure is on hospitals to achieve the new standards for care, long-term care facilities are viewed as a major source of variability in care cost and quality. A study released by CMS on the Bundled Payment for Care Improvement Initiative showed that average length of stay at skilled nursing facilities dropped by 1.3 days for patients in the orthopedic surgery episodes, while similar patients who were not in the BPCI program had no change in SNF length of stay.

It’s in the best interests of long-term care facilities to take the lead in proactively reaching out to hospitals to partner with them on cost-efficient, high-quality options to achieve optimal health care results for specific defined populations of patients.

That conversation should start with data. By getting hospitals to review utilization and cost data with them, long-term care facilities can partner in:

  1. Examining where the care community is performing well across the care episode lifecycle, and where it is falling short and why

  2. Drilling down and comparing how individual patients adjusted for case mix and co-morbidities compare across episodes of care

  3. Developing a clear path for improving processes and standards across all stakeholders impacting the episode of care, with the aim of becoming more efficient while improving quality and outcomes of care across defined episodes

Long-term care facilities have an opportunity to partner with providers and use their collective data about patient health status across the care continuum (inpatient, outpatient, and home care/readmissions). Doing so will provide new insights that can then be used to improve the patient experience throughout the entire episode of care.

First, however, long-term care facilities need to become experts in measuring and managing their own utilization, cost, and quality data. They can use their deeper understanding of where their inefficiencies are to demonstrate to providers how and where they’re improving, and where they can further improve over time. Measurement across episodes and care settings will enable new decisions that can bring about effective, positive change.

While hospitals don’t always have a choice over which long-term care facility their patients or physicians choose, the standards of CMS’s mandatory bundled payment programs will be more easily achieved through sharing of data and partnership of all stakeholders invested in the health of their patient populations.

Andrei Gonzales, M.D., is AVP, Product Management, Value Based Payments at McKesson Health Solutions.