Mr. Kelley outlined several steps for designing acute-care bundles:
1. Trigger: surgical procedure or hospital admission
2. Patient exclusions: severity of diagnosis, significant comorbidity, emergency vs. elective
3. Scope of services: hospital care; inpatient professional services; readmissions for related condition; outpatient office visits; rehab, home care or other follow-up care
4. Duration: all related services for trigger plus 90 days; readmissions for related conditions within 30 days; related specialist visits within 60 days; rehabilitation services within 90 days.
Data can help in the creation of these bundles by showing patterns across the continuum of care, Mr. Kelley said. Data can provide estimated variation in surgeon preferences; rates of referral to post-acute facilities; patient characteristics’ effect on required services and the resulting cost; prices for services provided in and out of network; the number, likelihood and potential causes of “outlier” patients; services that may or not be related to the bundle; and the number, likelihood and potential causes of readmissions.
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