Patient Care
A flat fee is set for procedures, doctors follow evidence-based protocols
Geisinger Health System has something to prove. It’s ProvenCare—a single-fee, evidence-based program attracting national interest.
Rather than wait for insurance companies to impose guidelines for pay for performance, the Pennsylvania health system sought to develop its own program, says Ronald A. Paulus, M.D., executive vice president and chief technology and innovation officer.
ProvenCare uses evidence-based benchmarks for patient care. Physicians compiled those steps from Geisinger’s electronic medical records system. Patients attend classes to learn about their upcoming procedures and become more involved in their care plan. Then there’s what has been dubbed “the warranty.” Geisinger covers follow-up care for avoidable complications within 90 days.
The program started with coronary artery bypass graft in February 2006. Within 18 months, Geisinger’s 30-day readmission rate dropped by 44 percent, among other improvements.
Currently, the single-price ticket and guarantee are available to Geisinger Health Plan members only, but the health system wants to expand. Paulus declines to reveal what plan members pay, though he says it falls within published data indicating a $25,000 to $40,000 range for CABG.
The single-price model is emerging elsewhere. Galichia Heart Hospital in Wichita, Kan., last February announced a $10,000 price for CABG—plus physician fees, capped at $2,000—to patients paying cash.
Paul Ginsburg, president of the Center for Studying Health System Change, says it will be hard to attract insurance companies to flat-fee procedures without leadership from Medicare.
But, Ginsburg says, Geisinger is “going to be very well-positioned, should Medicare move in that direction.’’
ProvenCare’s CABG success has inspired programs for other procedures, including hip replacement, cataract surgery and PCI/angioplasty.
Lynn Sickler, 56, of Sugarloaf, Pa., had both hips replaced through ProvenCare last year. She says she felt nurtured, as if Geisinger “had as much of a stake in me recovering quickly as I did.’’
On Dec. 2, Geisinger and Premier Inc. hosted executives from nine hospitals and health systems representing six states to learn about ProvenCare. Kim Hollon, CEO and executive vice president of Excela Health Hospitals in Pennsylvania attended with cardiac team members.
“They walked away saying, ‘Well, we do many of those things,’ ’’ Hollon recalls. “And I asked, ‘How frequently are we hitting 100 percent?’ We don’t know.’’ Benchmarks like Geisinger’s could help, he says.
Richard Gundling, vice president of thought leadership at the Healthcare Financial Management Association, says it’s about adaptability: Hospitals may not be able to fully adopt Geisinger’s model, “but they can do it other ways.’’
Proving What Works
By following evidence-based protocols as part of ProvenCare, Geisinger physicians have reduced complications related to coronary artery bypass graft. In the first 18 months of the program, 181 patients had an elective CABG. Here are some areas of care that improved.
|
Before ProvenCare |
With ProvenCare |
% Improvement/reduction |
Average total length of stay |
6.2 days |
5.7 days |
–– |
30-day readmission rates |
6.9% |
3.8% |
44% |
Patients w/ any complication |
38% |
30% |
21% |
Neurological complication |
1.5% |
0.6% |
60% |
Any pulmonary complication |
7% |
4% |
43% |
Re-operation for bleeding |
3.8% |
1.7% |
55% |
Deep sternal wound infection |
0.8% |
0.6% |
25% |
Source: Geisinger, 2008. Additional data can be found at: www.geisinger.org/provencare/numbers.html
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