Ready or not, change is coming to healthcare reimbursement and it’s already starting. The Department of Health and Human Services recently set goals and timelines for shifting Medicare payments from fee for service to fee for value. HHS aims to have 30% of reimbursement run through ACOs and bundled payment initiatives by 2016, and 50% by 2018. There are currently four bundled payment models in pilot programs, with Models 2 and 3 directly affecting long-term care. The goal of these models is to improve the coordination and quality of care at a lower cost by linking payment for multiple services that beneficiaries receive during an episode of care.
Peak Resources, a MatrixCare client, is one organization setting the pace by participating in the pilot program for Model 3 in all of their seven facilities. In Model 3, the care episode is triggered by a hospital stay, but begins with post-acute care services. “Participating in the pilot has opened many doors for us,” stated Todd Nunn, Peak Resource’s CEO. “The improved relationships we have with major hospitals and other healthcare providers is phenomenal. You couldn’t even leave a message with a CFO of a major hospital three years ago. Now that same CFO is getting together with his team to have conversations about how to achieve success in this new era of reimbursement.”
Technology is playing a key role in the bundled payment equation. MatrixCare – is helping organizations – like Peak Resources – improve patient care, gain operational efficiencies and broaden participation in bundled payment programs. “MatrixCare is helping us achieve our goals by helping us analyze data and identify issues before they happen in order to treat residents in place and keep them from going back to the hospital,” Nunn explained. At the time of clinical documentation, MatrixCare’s embedded Clinical Decision Support (CDS) alerts and reminders automatically trigger interventions and schedule follow-up activities. CDS supports bundled payment by helping providers, provider clinicians, and payers to use clinical evidence, as well as provider network and cost implications, to make informed decisions at the point of care. “Clinical Decision Support has really restructured our clinical meetings and we see exactly what Observations and Events have been done and we can define protocols to drive better outcomes,” added Nunn.
“The strategy we are taking with the pilot is monitoring the five primary diagnoses which were identified by evaluating readmission rates,” states Nunn. Those diagnoses being Chronic Obstructive Pulmonary Disease (COPD), Simple Pneumonia and Respiratory Infections, Congestive Heart Failure, Acute Myocardial Infarction, and Hip and Femur procedures except Major Joint are tracked using MatrixCare’s Observations and Events. “Because Model 3 pays for a bundle of services through retrospective reconciliation, we really are focusing on better care and keeping residents out of the hospital.” With this approach, Nunn added, “Last month we had 30 Medicare admissions and only two went back to the hospital. We don’t focus on the cost as it could take up to nine months for reconciliation with so many providers (i.e. pharmacies, equipment companies, etc.) involved. The primary thing is to analyze how many residents were admitted and how many went back into the hospital and how we can do things differently. We are also seeing terrific collaboration with acute care providers and home health agencies which has reduced 30 day readmission rates.”
As true EHR partners do, MatrixCare supports Peak with ways to ensure the best outcomes are met. “We can’t say enough about our partnership with MatrixCare,” stated Nunn. “Just recently they helped us set up a level of care for bundled payment and based on the DRG code, we can assign those residents that get admitted with the five primary diagnoses into the bundle.”
As the pilot program evolves, Nunn is looking forward to the innovation that is available with its EHR partner. MatrixCare is able to provide interoperability through API integration with other bundle partners, which automates and supports the bundle process. “In addition, I am looking forward to implementing MatrixCare DIRECT.” MatrixCare DIRECT allows providers to securely send continuity of care (CCD) documents, care summaries, lab results, and other resident information using the DIRECT standard, already in use by most hospitals and physicians. “This comprehensive communication with other providers in the bundle will help us with our goal of improved care at a lower cost.”
“Because we are still in pilot mode there is still uncertainty, but I can say that it’s incredibly fun right now,” said Nunn. “As I mentioned before, it’s opened many doors for us and the opportunities that lie ahead with MatrixCare and the bundled payment model are exciting! Instead of fearing change, we are now embracing it!”
Founded in 1999, Peak Resources is a family owned and operated company operating seven facilities in central and western North Carolina with a mission to serve the nursing and rehabilitation needs of the communities in which they are located. Peak Resources continually strives to enhance the quality of the lives of their residents, so that they may return home to their families. They also assist families with the difficulties in dealing with the end of life stages of their loved ones.
- Transitioning from payment defined by inputs to payment defined by outcomes
- Managing costs at the resident level rather than at the facility level
- Coordinating care with other healthcare providers participating in the bundle
MatrixCare® – EHR technology that supports bundled payment initiative focused on fee for value (outcomes) in addition to fee for service reimbursement that’s in place today.
- Improved relationships with hospitals and other healthcare providers participating in the bundle
- Increased efficiencies in documentation by using embedded clinical decision support
- Earned a reputation for being a proven thought leader in the industry