Advisor Live: Proposed Episode Payment Models for AMI, CABG, and Hip and Femur Fractures
CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI...
Transcript of CMS AMI and CABG Bundled Payment Initiative - AMGA AMI and CABG Presentation_vFinal.pdf · CMS AMI...
CMS AMI and CABG Bundled Payment
Initiative AMGA HF Collaborative
December 13, 2016
Collaborative Learnings − HF Correlation to AMI and CABG Bundled Payments
CMS AMI & CABG Bundled Payment
Programs
− Bundled Payment Background − AMI & CABG and HF Relationship
Survey Background − Survey Objectives − Target Audience
AMI & CABG Success Factors and Areas of
Opportunity
− The Key Success Factors − Main Obstacles and Opportunities for Improvement
Discussion How to leverage collaborative work to prepare for management of AMI & CABG bundled payments
Agenda
Care Team Coordination Using process mapping to standardize care
HF Collaborative
AMI & CABG Bundled
Payments
Patient Stratification Identifying and managing high risk patients
Medication Management Communicating about medication changes
Collaborative Learnings
About the Bundle
• 90-day episode of care
• Retrospective with annual
reconciliation
• Participants are 98 randomly
selected MSAs
• Payment for Quality
• CMS is offering an incentive for
cardiac rehab services post-discharge
• Impact on MACRA participation
October 2016
Deadline for Proposed Rule Comments
Late 2016/Early 2017
Final Rule Publication and MSAs Announced
July 1, 2017 First Performance
Period Begins
July 2016
AMI & CABG Bundled Payment Announced
TODAY
December 31, 2017
First Performance Period Ends
AMI & CABG Bundled Payments
Included MS-DRGs
• CABG 231-236
• AMI 280-282
• PCI 246-251 with an AMI ICD-10
principal or secondary diagnosis code
Measurement Categories
• Length of Stay
• Readmission Rates
• Mortality Rates
• Patient Satisfaction Rates
Survey Background Distributed from November 18- December 1
Survey objectives: • Identify potential barriers to implementing
bundled payment programs
• Determine the necessary resources to be
successful in procedure and event-based bundled
payments
• Assess bundled payments performance readiness
• Define opportunities to support heart failure
management within cardiac bundle payment
implementation
Survey Participants Targeted participants:
• Nation-wide providers at integrated delivery networks
• MD or PharmD credentials were primary respondents
Participant’s Role Specialty Care Physician
Physician Assistant, NP, Nurse Midwife,APN, etc.PharmD or pharmacy assistant
Management; Practice Manager, OfficemanagerOther (please specify)
Specialty Care Physician
Physician Extender
PharmD
Practice Management
Other*
*Other: Primary Care in leadership position: C-Suite, Executive
Clinical Council, Medical Director, Clinical Care Coordinator
Bundled Payment Survey A non-scientific study designed to provide directional information on how we might use the learning/best practices from the HF collaborative to succeed in the CABG/AMI bundles
Current Bundled Payment
Performance
• Includes BPCI and CCJR
• 100% believe they have room
for improvement, but also
acknowledge that they are
doing well
• 55% of respondents are
currently participating in
bundled payment programs
How do respondents categorize their organization's potential performance?
Excellent
Very good, but withroom for improvement
Good, but still somework to do
Unsatisfactory, butmaking progress
Poor
Bundled Payment Performance
“Very Good” vs. “Good” -> Differentiating factor is extent of program infrastructure
C om m on B e s t Pra ct ice s
Service Line Structure Integrated Service Lines and Care Teams:
Primary Care, Pharmacists and Quality Departments
Transition of care discharge services:
Pharmacy-based clinics (Coumadin, etc.)
Home health
Post-acute management and rehab
Tele-medicine:
Only 50% of respondents have tele-monitoring resources
Bundled Payment Implementation Teams
Designated Implementation Teams:
100% of those with a bundled payment implementation
team feel they are performing “very well with some room
for improvement”
Streamlined Processes:
Either an AMI or CABG pathway developed; pathways
include system formulary preferences
Success Factors: What do those responding “very good” have in common?
Standardized Clinical Workflows
Post-Discharge Care Coordination
Staff Education
What did respondents identify as the biggest barriers to implementing AMI
and CABG bundled payment programs?
Areas of Opportunity
Standardized Clinical Workflows
Post-Discharge Care Coordination
Staff Education
Expand Collaboration with Discharge Destinations
• The majority of a patient’s costs are after discharge
• Over 60% identified patient access to post discharge
services as a barrier
• Opportunities to expand:
• Pharmacy integration
• Tele-monitoring
• Coordination for Post-Discharge care
Post-Acute Facilities
Cardiac Rehab
Home Care
Primary Care
Post-Discharge Care Coordination
Standardized Clinical Workflows
Post-Discharge Care Coordination
Staff Education
• Expect clinical pathways to change
• 85% plan on exploring clinical workflow process
improvements through the AMI and CABG bundled
payment initiative
• Other bundled payment programs show key steps are:
• Identifying patients
• Conducting risk stratification
• Determining appropriate discharge destination
• Establishing care coordination and transitioning
care teams
What do you see as potential barriers to implementing AMI and CABG bundled payments at your organization?
Resistance to standardization
of care
50%
Standardized Clinical Workflows
Standardized Clinical Workflows
Post-Discharge Care Coordination
Staff Education
Bundled payment topics for staff education missing in respondents’ health systems…
• Develop necessary quality reports and educate staff on
responsibilities and appropriate follow-up actions
• CMS plans to monitor:
• Length of Stay
• Readmission Rates
• Mortality Rates
• Patient Satisfaction Rates
• The culture of transparent reporting
0% 10% 20% 30% 40% 50% 60%
Utilizing quality reports:Interpreting and acting on results
Impact of bundled payments
Clinical workflow training
Staff Education
Bringing It All Together
• Everyone has challenges with bundled payment programs
• Keys to success include:
• Designating a care team to manage bundled payments
• Increasing access and management of post-discharge services
• Streamlining workflows, consider:
• Early identification of patients
• A process for stratifying risk
• Discharge coordination
• Incorporate primary care, quality departments, and pharmacy
• Monitor patients’ adherence, based on assessed clinical risk
• Providing education about quality reports, bundled payment impacts, and
clinical workflows
What’s Next: As you continue to implement changes from the HF collaborative, think about
how you can incorporate initiatives supporting AMI and CABG
Discussion