How tech, physician alignment can improve value of TJR episodes of care

CMS initiated started bundled payment initiatives to link payments for the multiple services patients received during an episode of care for the purposes of improving care quality. As the industry's shift to value-based reimbursement models continues, private payers have similarly followed suit.

The implementation of bundled payment models requires an investment of time and resources for all participating providers, according to Richard Iorio, MD, chief of adult reconstruction and total joint arthroplasty service and vice chairman of clinical effectiveness at Brigham and Women's Hospital in Boston.

Dr. Iorio presented his thoughts on how technology and medical staff alignment can improve the value of total joint replacement episodes of care under bundled payments during a Oct. 2 webinar sponsored by Pacira Pharmaceuticals and hosted by Becker's Hospital Review. He was joined by Ritesh R. Shah, MD, an orthopedic surgeon at the Arlington Heights-based Illinois Bone and Joint Institute, and James Slover, MD, associate professor of the adult reconstructive division in the  orthopedic surgery department at NYU Langone Orthopedic Hospital in New York City.

The presenters highlighted several clinical pillars of bundled payment success — the first of which involves minimizing patients' risk for complications to improve outcomes and reduce readmissions.

"We really needed to emphasize the ability to minimize complications," Dr. Slover said. "We began to look at various areas where we felt patients had comorbidities that were modifiable and examine how we could institute programs to make them healthier so that they would do better with surgery."

Dr. Slover said hospitals and health systems can implement a series of protocols, such as the Readmission Risk Assessment Tool, to help minimize patients' risk for complications. Those protocols can be regulated by technology platforms and EMRs. New York City-based NYU Langone Medical Center used such protocols, Dr. Slover said, and found its 90-day readmission rate of Medicare TJA patients drop from roughly 12 percent in 2013 (prior to the implementation) to roughly 8 percent in 2016.

While assessing the success of such technology for TJR patients may be difficult, Dr. Slover said it is ultimately worth studying.

"It's very difficult to assess these types of [tech] changes and innovations because TJR is such a successful operation to begin with. But nonetheless, I think it's worth doing. Patients are having these operations at younger ages; they're living longer. We want to make sure we create value that's not only there for the episode or the first 90 days, but throughout [patients'] lifetimes," he said.

Another critical piece of successful bundled payment implementation is care coordination, Dr. Shah noted. Providers can utilize care management platforms to track a patient's episode of care. Implementing such technology also helps facilitate communication between the patient, their physician and their care teams.

"The care coordination pieces were the most important pieces, to help a patient get through their episode of care," Dr. Shah said. "From a value or cost-savings standpoint, [providers must] make sure that patients receive an appropriate episode of care."

Dr. Iorio highlighted the industry's growing reliance on bundled payments, despite some setbacks. According to him, more commercial payers will continue to adopt bundled payment models, compelling hospitals and health systems to introduce or improve on their bundled payment options as well.

"Using these disciplines is going to become critical so [hospitals] don't lose money," Dr. Iorio said. "The commercial payers are very rapidly going to adopt this methodology, so I think taking a chance and entering into one of these voluntary bundled payment programs may allow you to become … more successful in the private arena when you're asked to bundle your programs."

To view the webinar, click here. To access the webinar slides, click here.

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