Only 3 percent of hospitals meet CMS target for value-based care

Less than a quarter of U.S. hospitals are expected to meet the government’s goal of providing half or more of their patients with value-based care – the initiative designed to replace fee-for-service Medicare reimbursement with healthcare provider payments based on care quality, according to a survey conducted by Health Catalyst. The survey revealed that just 3 percent of health systems today meet the target set by the Centers for Medicare and Medicaid Services. Moreover, only 23 percent expect to reach the goal by 2019, a year later than CMS expected half of all Medicare reimbursements to be value-based. Fifty-two percent of respondents indicated analytics would be critical to success in a value-based system – more than double the second most-selected answer: a culture of quality improvement. Twenty-four percent of respondents cited cultural alignment on quality as having the most impact on value-based care success. “Transitioning from fee-for-service reimbursement to value-based payments is a goal that many healthcare organizations embrace but are having difficulty implementing as they juggle a number of other high priorities,” Health Catalyst vice president Bobbi Brown said in a statement. “This survey reveals that they’re making progress but they could use a little help – some of it financial and some of it technical in the way of better analytics to help identify at-risk populations and better manage their risk.” The survey shows 62 percent of health systems have zero or less than 10 percent of their care tied to value-based care and payments, and those numbers include accountable care organizations. Small hospitals with fewer than 200 beds make up the majority of those lagging on... read more

AJRR announces new patient-reported outcome measures guide.

The American Joint Replacement Registry recently published a guide on their new level 3 patient-reported outcome platform and how to use it to capture data, according to a press release. The patient-reported outcome (PRO) platform was developed within the American Joint Replacement Registry’s (AJRR) Demand Reporting & Electronic Dashboard system. Clinical staff can reportedly manage PRO surveys electronically through a secure patient portal while accessing patient data. Site-specific patient reports and summary results can also be pulled by the AJRR Dashboard system for each PRO measure supported on the system. Several tables that summarize PRO measures collected by the AJRR will be featured in the guide, as well as the specific measures recommended, the release noted. These measures include a list of questions hospital staff might ask before beginning a program, workflow diagrams that show how data could be submitted into the registry and a section devoted to lessons learned from the participants. According to the release, there is no additional cost for using the level 3 platform. “PROs are becoming more and more important to health care, as the federal government continues to emphasize their use with programs and quality initiatives,” Daniel J. Berry, MD, chair of the AJRR board of directors, said in the press release. “We want to ensure that our platform is relevant to practicing physicians, and that they are getting the most out of what we have to offer. Our new guide is perfect for pointing institutions in the right direction when forming a program and helping hospitals that already collect PROs to adjust in a way that makes data submission simpler.” Orthopedics Today... read more

8 ways to improve patient satisfaction and the patient experience–and, as an aside, improve your HCAHPS scores.

1. If you want to stem patient dissatisfaction, stop giving off cues of indifference and uncaring. Such as: Healthcare professionals avoiding eye contact with “civilians.” Med students hurrying self-importantly down the halls, nearly running down the slow-moving patients who won’t get with the program. Patients ignored by nurses who haven’t yet clocked in and therefore don’t realize they are already (poorly) representing their institution. Doctors in the hallway loudly carrying on about the relative benefits of different Canyon Ranch vacations they’ve taken. Two radios playing at once from two administrative areas (with the waiting area for patients and their families located equidistant to both). Vending machines that are left out of service indefinitely. Vending machines that require exact change, but there’s no change machine. 2. Strive actively to experience your care the way that your patients do. Park where the patients do. See how easy it is/isn’t to get to the front door on crutches. Take a tour of your hospital with someone who hasn’t been there before, and let them show you whether they can really find where they’re going. You’ll be amazed how many mis-aligned, out of date, confusing signs you have. It all makes intuitive sense to you, of course, because you have been in your building enough times that you know your way around in your sleep (Literally, I suspect.) And, once a year, do a “full bladder exercise”: Everyone who works with patients should drink two or three liters of water–it is incredible how your perception of a “reasonable delay” between call button and response changes when you have a full bladder. 3. Get... read more

How hospitals are prepping for Medicare’s mandatory bundled-pay test

Hospitals in dozens of U.S. markets are now cramming for a compulsory test of Medicare payment reform. The hardest part may be that their success relies on the work of partners they aren’t used to collaborating with. Hospitals in 67 metropolitan areas learned this week they have no choice but to accept a single sum for the cost of care during and 90 days after patients visit the hospital for hip and knee replacement surgery, a strategy known as bundled payments. (See the areas and hospitals included.) The mandatory initiative, proposed in June, is widely viewed as evidence of federal officials’ impatience with the industry’s shift away from charging Medicare for each visit, test and procedure. While many providers have signed up for one or more of several payment reform programs launched under the Affordable Care Act, the Obama administration has expressed an ambition to move much more quickly. The new bundled-payment program also clearly signals an expectation by federal officials that hospitals will do more to coordinate care after patients leave, said Robert Mechanic, executive director of the Health Industry Forum at Brandeis University. “It’s a push to start to change the culture inside of hospitals,” Mechanic said. “What they do can’t stop at the hospital wall.” Home-care and post-acute care providers such as skilled-nursing facilities are large expenses for Medicare joint replacement patients, and the cost and quality of that care varies significantly. “That’s actually where a lot of the significant cost reduction can occur,” said Dr. Michael McKenna, executive vice president and chief medical officer of McLaren Health Care. McLaren’s hospital in Flint, Mich., will have... read more

Joint replacement surgery made easier

Joint replacement surgery used to require a week-long stay in the hospital, and a long painful recovery. Not so any more. Enhanced recovery means walking into the hospital one morning, and walking out the next, with a new hip. Six months ago, after getting a total hip replacement, Dallas realtor Mary Cotroneo left the hospital the very next day and was back at work within two weeks. Cotroneo said, “Everybody’s jaw dropped when I walked into the meeting. They couldn’t believe it.” Jay Mabrey, MD, Chief of Orthopedics at Baylor University Medical Center, said, “We’ve gotten it down to where we can actually measure your length of stay in the hospital in terms of hours not days.” The breakthrough, called enhanced recovery, is a new approach to anesthesia. Patients can drink water two hours before surgery. They get a spinal block instead of a general anesthesia, a short-acting drug for sedation, and localized pain management, to cut down on the use of morphine and opioids. Ryan Hanson, MD, anesthesiologist at USAP, said, “And if we can avoid that class of medications or reduce their use, then we are potentially increasing the patient’s safety as well as reducing the complication rate long term.” Dr. Mabrey said, “Patients wake up with little if any pain, little if any nausea, and they are ready for physical therapy within an hour or two after their surgery.” Now that she’s been through it, Mary says there’s no reason to fear the surgery or put it off. “Here I am, I mean six months into it, and I feel like a new person. Still going... read more