The Impact of a Hospital Post-Acute Care Program on Value-Based Care
As Medicare’s Bundled Payments for Care Improvement Advanced (BPCI-A) model continues to incentivize the transition towards value-based care, hospitals are innovating with new services and capabilities to meet its goals.
One of those hospitals, Los Angeles-based CHA Hollywood Presbyterian Medical Center (CHA-HPMC), a subsidiary of CHA Medical Group, was accepted to participate as part of the first cohort of hospitals to improve quality of care as part of Medicare’s BPCI-A initiative.
CHA-HPMC has designed and implemented a Continuing Care Program, a post-acute care program that continues high-quality care during a 90-day period after discharge for Medicare patients with certain diagnoses, such as sepsis. Patients who are 65 and older are especially susceptible to sepsis, the body’s extreme systemic response to an infection.
“The primary goal of the Continuing Care Program is to deliver higher quality patient care, from the perspective of improving patient satisfaction, reducing readmission rates, and getting more patients discharged to home. By effectively achieving these goals, we are also decreasing the cost of care to CMS,” says Jamie Chang, MD, MBA, FACEP, an emergency medicine physician who serves as chief of clinical operations at CHA HPMC and has overseen the design and implementation of the Continuing Care Program. “We are operating during a period of transition from fee-for-service to value-based reimbursement, particularly for the Medicare population.”
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“As more and more financial risk for the costs of care are shifted to hospital providers, there needs to be increasing attention toward the costs that are incurred not just during the acute hospital encounter, but also the costs of care after discharge,” Chang says. “This change to value-based reimbursement is inevitable for traditional Medicare—the only decision for hospitals is whether they will adapt to this change before it is mandated.”
Bundled payments represent one innovative payment model that is designed to move toward value-based care by incentivizing hospitals to enhance coordination and efficiency of care to achieve higher quality outcomes at lower cost, according to Chang.
In the BPCI-A program, CMS sets a “target price” for an episode of care, which includes both the acute inpatient hospitalization plus 90 days after discharge. Different diagnoses are attributed different target prices, and the hospital has the option to choose which diagnoses it wants to follow as part of the program.
“If the cost of care for CHA HPMC’s patients is below the target price for the episode, then CHA HPMC receives payment from CMS for the cost savings in the form of a ‘reconciliation payment’,” according to Chang. “However, if the cost of care for CHA HPMC’s patients is above the target price for the episode, then CHA HPMC must pay a penalty back to CMS.”
The Continuing Care Program includes a robust documentation and coding effort to identify patients as soon as possible after admission to the hospital. A team of patient navigators then meet with the patient at bedside during the acute hospitalization, and coordinate discharge plans with CHA HPMC’s case management team to ensure a successful transition out of the hospital.
“Once the patient is discharged, we have an on-campus care transition clinic to ensure every patient has a PCP-level visit as soon as possible after discharge,” Chang says. “We also have a team of nurses who conduct a home-based evaluation and can support our patients at home 24/7 through the use of a triage phone line and collaborative workflows with the hospital’s outpatient pharmacy to deliver care to the patient at home.”
Date: June 28, 2019
Source: Managed Healthcare Executive