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It takes a lot of planning and oversight for hospitals to succeed financially under bundled payment initiatives, which work best when representatives from all levels of the healthcare continuum work together, says John Wagner, associate director at Berkeley Research Group.
“The new Bundled Payments for Care Improvement Advanced program is an opportunity for hospitals, physicians, and post-acute providers to work collaboratively to improve the quality of care,” says Ken Steele, principal with ECG Management Consultants.
Program participants are responsible for the entire episode, up until 90 days post-acute, which makes collaboration among everyone who touches the patient imperative, he adds.
“There’s always a learning curve as new systems go into place. There has to be a committee that oversees the process and makes changes to improve it,” Steele says. The hospital staff on the committee should include representatives from admission, nursing, surgery, the medical floors, and IT, as well as the physician champion of the service line the bundle is in, he adds.
The role of the oversight committee should be to review the contracts, collect and analyze data, and identify the opportunities the hospital would have, says Brian Pisarsky, RN, MHA, ACM, director at KPMG Healthcare Solutions. The physician champion from each service line involved in the project should make sure the team stays on track and risks to the hospital are mitigated, he says.
Case management consultant Donna Hopkins, MS, RN, CMAC, suggests setting up service line-specific committees for each grouping of clinical episodes with common elements. For instance, there are multiple clinical episodes in the program that fall into the category of cardiac diagnoses. There also are several orthopedic and gastrointestinal diagnoses that can be grouped together for the purpose of oversight, she says.
“Representatives from all levels of the healthcare continuum must work together to eliminate duplication and reduce waste,” she says.
Bring together all stakeholders from across the continuum and work together on best practices. Look for ways to reduce costs, and monitor progress, she says. Case managers should be active participants in the committee, she adds.
Hopkins suggests that hospitals review the roles and responsibilities of everyone who will touch the patient during the 90-day episode of care and identify any duplications. Make changes to eliminate any duplication.
One frequent source of duplication is post-discharge phone calls. In some instances, they are being conducted by nurses or case managers, patient navigators, and pharmacists in the hospital setting as well as case managers from insurance companies and physician offices. “Not only is this an inefficient duplication of services, it also annoys patients when they get multiple phone calls asking the same questions,” Hopkins says.
Financial Disclosure: Author Mary Booth Thomas, Editor Jill Drachenberg, Editor Jesse Saffron, Editorial Group Manager Terrey L. Hatcher, and Nurse Planner Toni Cesta, PhD, RN, FAAN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.
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