Hospitals will have to risk financial losses for poor outcomes as Medicare changes how it pays providers.

Surgeons at Akron General Medical Center are rethinking their whole approach to hip and knee replacement surgery. The transformation underway in Akron will sweep through hospitals in 67 cities next year and eventually thousands nationwide. The stakes are high. Failure to get it right could cost the hospitals millions, as Medicare begins phasing in plans to pay hospitals not for the number of services they provide but for high-quality episodes of care provided at the lowest possible cost. CMS announced Monday that the most ambitious phase of the new program will begin April 1, 2016, when Medicare will begin putting in place a plan to put each hospital at financial risk for the cost and quality of each joint replacement procedure, including care provided outside the hospital for up to 90 days. Putting hospitals at financial risk for the cost of care is a powerful incentive to get it right. Unnecessary procedures, complications, hospital readmissions and extended care provided in costly “post-acute” settings such as rehabilitation centers all may drive up costs and increase the likelihood that hospitals will end the year owing Medicare money. Hospitals that reap savings will be able to reward physicians and other care providers, providing them too with an incentive to boost quality and cut cost. Hip and knee surgery is just the beginning. Goals set by Health and Human Services Secretary Silvia Burwell this year require half of all Medicare payments to be shifted into alternative models like the Comprehensive Care for Joint Replacement (CCJR) program by 2018, while 90 percent of payments will be tied to the quality of care. Dr. Patrick... read more

Studying Benefits of Weight Loss Surgery Before Knee Replacement

GEISINGER HEALTH SYSTEM; DANVILLE, PA — People struggling with obesity are more likely to have trouble with their knees. But there’s a problem: if you weigh too much, most surgeons will say no to a knee replacement surgery.So now Geisinger is leading a study looking at the benefits of patients having weight loss surgery first to make knee surgery possible, or maybe even prevent the need to replace that knee.Joanne Walsh’s physical struggles are easy to see. One of her knees is so bad that she’s barely able to walk. Doctors at Geisinger near Danville believe her weight issues are contributing to that. But before Joanne can get knee replacement surgery, the woman from the northern tier must lose weight. To do that, she is getting bariatric weight loss surgery.”I’m only 50, so I’m ready. I’m ready for the changes. I had some other health issues before this that led up to this, but now it’s time to get on the road to better health,” Walsh said.Joanne says when her knee started to get bad, it impacted her job as a licensed veterinary technician. She had to a take a desk job.Her mobility was limited, and her weight gain increased.”When you can’t exercise and do normal activities, the weight just piles on, so it’s a catch 22.”Joanne is now a patient of Dr. Christopher Still, the head of Geisinger’s obesity institute. He believes there are a lot of cases like hers.”So there are a lot of patients out there who are told go lose weight and come back when you lose weight and we will replace your knee,” said... read more

5 ways to fuel patient engagement

“We can’t just say we need more and more people engaged, we need to have particular targets” There’s little question that patient engagement is one of the most promising trends in healthcare today. Indeed, the potential – in terms of cost-savings, personalized patient care and healthier populations – is unmatched. The reality, however, is that the industry has a long way to go before reaching the Holy Grail of patients harnessing technologies to own their own healthcare and more effectively interact with caregivers and clinicians. Those were the overarching themes at the HIMSS and Healthcare IT News Patient Engagement Summit in San Diego this week. Among the takeaways are these five things that need to happen for patient engagement to move from the abstract to the concrete: 1. It’s time to end information asymmetry. Why? “It’s a burden,” according to Danny Sands, MD, and it must be displaced, pronto. The problem is that patients and providers don’t have the same information very often – let alone at the same time. Sands didn’t stop there: “We have this visit-based system that developed 100 years ago. People didn’t develop chronic conditions, everything was acute. That doesn’t make sense in a world of chronic conditions.” No one said it would be easy but Clark Kegley, assistant vice president for information services for Scripps Health, pointed out that “patient engagement is not how much money I can make in the next 30 minutes. It’s how much of an impact I can have over the next 30 years.” 2. Less engagement, not more. Neither blaming, nor shaming, nor bombarding patients with reminders is going... read more

Hips don’t lie: A look inside CMS’ joint replacement bundled payment rule

Brief: HHS and the Centers for Medicare & Medicaid Services’ Innovation Center have finalized the Comprehensive Care for Joint Replacement Model. The model will test bundled payment and quality measurement for hip and knee replacements and/or major leg procedures. The model is to encourage hospitals, physicians, and post-acute care providers to work together to improve quality and coordination of care throughout an entire episode of care. The model is set to go live April 1, 2016, unless the federal agencies have a cruel sense of humor. This model is being tested in 67 geographic areas throughout the country, and nearly all hospitals in those geographic areas are required to participate. Insight: Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries. In 2014, there were more than 400,000 procedures, costing more than $7 billion for the hospitalizations alone. However, the quality and cost of care for these hip and knee replacement surgeries still varies greatly. The average total Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas. Under this model, the hospital in which the hip or knee replacement and/or other major leg procedure takes place will be accountable for the costs and quality of related care from the time of the surgery through 90 days after hospital discharge. Depending on the hospital’s quality and cost performance during the episode, the hospital will either earn a financial reward or, beginning with the second performance year, be required to repay Medicare for a portion of the spending above an established target. According to CMS, this payment structure gives hospitals an incentive... read more

Medicare Launches Major Payment Shift for Hip, Knee Surgery

Striving for better quality and more predictable costs, Medicare on Monday launched a major payment change for hip and knee replacements, the most common inpatient surgery for its 55 million beneficiaries. Starting April 1, hospitals in 67 metropolitan areas — from Akron, Ohio, to Wichita, Kansas — will be held responsible for the results of hip and knee replacements. The aim is better coordination that starts with the surgery itself, and continues through recovery and rehabilitation. For the Obama administration, it’s part of a turn away from paying for a piecemeal approach to care, regardless of results. The new direction aims to foster accountability among hospitals, doctors, nursing homes and home health agencies. It mirrors shifts occurring in employer-sponsored insurance and has support, in principle, from lawmakers of both parties. Under the new system, hospitals can receive additional financial rewards by meeting certain targets for quality and overall costs. If they fall short, eventually they will be financially liable. Medicare recipients will still be able to pick doctors and hospitals for their surgeries. Beneficiaries had about 400,000 hip and knee replacements last year, ranging in cost from $16,500 to $33,000 across the nation. Quality also varied, with rates of complications more than three times higher for some hospitals than others. Researchers believe such wide disparities reflect inefficiency and waste in the health care system, not just regional differences in the cost of doing business. Research has shown that patients usually fare better with surgeons who perform a high volume of hip and knee replacements, and who are operating in hospitals that handle a large number of the procedures. Medicare... read more

Mike Sebek, PA-C Joins miTRAX

miTRAX announced the appointment of Mike Sebek as Technology Specialist – Physician Assistant. Sebek a Nebraska native, completed his undergraduate studies at Nebraska Wesleyan University and his medical training at the University of Nebraska Medical Center in Omaha, Nebraska. In his role, Mike will serve as a clinical process and procedural resource to... read more