As hospitals move to a payment model that rewards value over volume, many experts believe that bundling together one payment for an entire episode is a essential step in the process. Sometimes, however, it can be challenging to get docs to see the entire chain of events that a patient is subjected to before and after surgery. Leaders from a couple of such successful bundle programs gathered to chew over some of the hurdles to success during a chat convened by the Institute for Healthcare Improvement last week.
If providers want to excel in these new value-based payment models, they need to focus on the outcomes that matter most for patients, and understand what's happening during the entire episode of care, says Mark Jarrett, M.D., chief quality officer and senior vice president of North Shore-LIJ Health System, in Great Neck, N.Y.
“From the physician's viewpoint, the hardest thing for them — especially procedure-oriented physicians such as surgeons — is to think in terms of the big picture. To think of, not only what occurs in the hospital, but what occurs across the whole continuum of care,” says Jarrett, who made the previously mentioned car analogy. “They can't just think in terms of the medicine of it, but really it's about the total patient.”
It's a bit of a cliché in health care, but with bundled payment initiatives, gaining buy-in from docs really is critical, speakers outlined during the chat. Physicians need to hear the rationale for why the hospital is trying such an arrangement, and how it will improve the patient experience, adds Jarrett. Plus, North Shore-LIJ — which is going global payment with total joint replacements, chronic obstructive pulmonary disease patients and coronary bypass surgery — made sure to give its clinicians all the necessary support. That way, doctors are lasered in on caring for patients and not getting bogged down by some of the administrative duties required.
Over at Baystate Medical Center, in Springfield, Mass., they've found that it's critical to carefully manage your post-acute resources and build strong relationships with those institutions, says Alice Ehresman, R.N., health care quality specialist. So much of a patient's time is spent out of your purview in the skilled nursing facilities or rehab centers that you can't just leave what happens there to chance.
Naturally, when you're dealing with a bunch of scientists, real-time data has proven essential to the success Baystate. When Ehresman shared quality data with surgeons, compared to national benchmarks, she at first was careful to redact the names of physicians. But after awhile, they asked for an end to that practice, as curiosity and competitiveness took over.
Premier, which is undertaking a bundled payment collaborative with thousands of institutions involved, has also found data to be a key cog in any such efforts, says Mark Hiller, vice president for innovative solutions. Sometimes, however, it's not easy to see the truth at first.
“What we find shocks a lot of people,” Hiller says. “We've had physicians get visibly upset when they start to recognize and see, sometimes for the first time, what their patients actually go through in terms of the 90 days post discharge from their operation. I think that these bundles have been a great experiment and an opportunity to bring so many different providers together to really focus on the right things, and I'm very, very optimistic about this model being successful over time.”