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Success under bundled payments requires using past data to identify opportunities for improvement and analyzing current trends to uncover problematic situations and make changes in real time, according to Brian Pisarsky, RN, MHA, ACM, director at KPMG Healthcare Solutions.
Case management leadership should start collecting data now to understand where opportunities for improvement lie, Pisarsky suggests. “What’s required under bundled payments isn’t something new — it’s just a new way to pay for care,” Pisarsky says.
Use historical data to plan for the future, Pisarsky suggests.
“The key to succeeding under bundled payments is to use data from the past to determine what physicians, hospital leadership, and case management leadership need to do differently to improve the cost per case and improve patient outcomes,” Pisarsky says.
Review the data for several months so you’ll be aware of any issues to tackle before BPCI Advanced kicks off, he adds.
If your hospital already uses bundled payment arrangements, analyze them to see how you’re doing. Otherwise, analyze the past cases that would fall into a bundle your hospital is applying for and determine whether the hospital would have won or lost financially under bundled payments. Go back six months or a year and make case-by-case examinations, then drill down on the outlier cases to see what you could improve.
One of case management’s important roles in a bundled payment program is to manage resource consumption, says Teresa Marshall, RN, MS, CCM, senior managing consultant for Berkeley Research Group. This means case managers must know the cost of services as well as the target length of stay, she says.
Now more than ever, hospitals must employ data analysts to help them understand the costs, says Beverly Cunningham, RN, MS, ACM, consultant and partner at Oklahoma-based Case Management Concepts.
“When the new bundled payments program starts, case managers will need to be more cautious about how much is spent and how long the patient stays. The case manager should analyze all charges and costs and compare the cost of care to the target price,” Cunningham says.
Case managers should know the length of stay and cost for each component of each bundle the hospital leadership chooses. “They need to have intense data analysis and know exactly what they are taking on,” she says.
Look at the trends over the past year and compare past costs to price targets set by CMS, then look for ways to lower costs, she says.
After the October start of the program, immediately start collecting and analyzing data and looking at patterns and trends, Pisarsky says. “If one bundle has a lot of readmissions, or the length of stay starts creeping up, it’s helpful to know early on so you can make immediate changes toward improved outcomes,” he says.
Make sure the entire staff understands their role in the new system, Pisarsky says. This likely means multiple educational sessions for ED case management staff as well as inpatient social workers and case managers, he adds.
Data are extremely important to the success of a bundled payment program, Marshall says. Case managers should collect data about every bundled payment and manage it as closely as possible, she says.
“Case managers need to analyze readmissions, drill down to find the cause, and come up with a solution to prevent the next one, and make changes as soon as possible after readmissions are identified,” she says.
Case managers should work with their counterparts in physician offices and post-acute providers to reduce variation in reporting so data will be complete, adds John Wagner, associate director at Berkeley Research Group.
It’s essential for case managers to have recent data when they take up an issue with a provider or their physician advisor, Marshall says.
When your data reveal outliers whose outcomes are not on par with those of their peers, show them data that compare their results to other clinicians’ data, Wagner adds.
“If the bundled payment program works as designed, every individual or organization that delivers care that is following the protocols and clinical pathways should have better outcomes data than those who choose to do it their own way. Data is a strong tool to use with the more reticent providers to convince them to change their methods,” Wagner states.
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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