TEAM requires selected hospitals to coordinate post-acute care for Medicare beneficiaries who have undergone one of five surgeries: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft and major bowel procedure. Beyond care coordination, hospitals will be responsible for the patient’s care quality and costs for 30 days after discharge from the hospital.
The model aims to “incentivize care coordination, improve patient care transitions and decrease the risk of avoidable readmission,” according to the CMS website.
Steve Carr is chief sales officer of New York City-based Centers Health Care, which has developed a TEAM resource for hospitals. He spoke to Becker’s about what participating hospitals should be doing to prepare for the new payment model.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is the biggest challenge facing hospitals who have been chosen to participate in TEAM?
Mr. Steve Carr: The biggest challenge is identifying which skilled nursing facility partners can best execute and commit to an accountable care model. Publicly available information, like five-star ratings and the State Department of Health surveys, don’t indicate what type of care management or leadership exists within an organization, which is going to be required to drive results.
I encourage all hospitals to dig deeper when looking at what’s really going to matter under TEAM. If they take that proactive approach, they can hone in on the key questions: How are you set up from a medical management perspective? What kind of volume experience do you have in these diagnoses? What kind of clinical support do your facilities have access to from a policy and procedure standpoint? When you develop your care paths, policies and procedures to guide the care team along the route to success, that’s where you can really start to make a difference
Get in there, ask those questions. It’s not that different from building a program in the acute care setting. I think the same issues are in play as hospitals evaluate potential skilled nursing facility partners for the team as well.
Q: How do you recommend hospitals go about establishing post-acute care partnerships?
SC: The first thing is trying to understand what goals need to be achieved. As that’s developing, meeting with the skilled nursing facilities to discuss those goals and learning how the skilled nursing facilities will support those goals is critical.
The other part that should be quickly figured out is who the program leads on both sides are, and then developing key, measurable metrics together to define success.
The hospitals that get serious about that, and have the willingness to meet with their post-acute partners, will gain insight and can start to learn what the skilled nursing facility can contribute in the form of resources and capability. From there, they can build out pathways and measurements that will allow them to keep things on track.
Once hospitals develop these key partnerships, they can confidently let patients know, “These are our best partners in this model because of X, Y and Z.”
