Skilled nursing facility (SNF) professionals at the forefront of the Bundled Payments for Care Improvement (BPCI) movement will gather in Orlando for a two-day collaborative event starting on Thursday, April 7, 2016.
When you deposit your paycheck, you expect your bank to process it. If you travel out of town, you count on being able to access your money from an ATM. But patients discharged from the hospital to a rehabilitation center or nursing home may not experience such a seamless transition of their healthcare information.
This useful information exchange is called interoperability, and the lack of it can cause serious issues for patients. Communication breakdowns are a key cause of medication errors. One report indicates that “an estimated 60% of medication errors occur during times of transition." This puts patients at risk for poor outcomes, including rehospitalization.
The Society of Hospital Medicine recognizes 2016 as the Year of the Hospitalist, commemorating 20 years since the term hospitalist was coined and the Society of Hospital Medicine was formed. Bob Wachter and Lee Goldman sparked the latent hospitalist movement with an article titled ‘The emerging role of ‘hospitalists’ in the American Healthcare System’ in an August 1996 issue of The New England Journal of Medicine. Several weeks later, John Nelson and I, both practicing hospitalists, formed the Society of Hospital Medicine (then incorporated in 1997).
Bundled payment programs require effective care coordination encompassing the hospitalization and the post-discharge recovery period. Within this care coordination process, selecting the ‘next site of care’ after hospital discharge is a crucial element in the provision of high value patient care. Why? When looking at large data sets representing aggregate spending, the cost of post-acute care can rival that of the initial inpatient stay. For many bundles, total 90-day episode spending for a patient discharged to a skilled nursing facility can be more than two times that of a patient discharged to home.
Acute care BPCI participants nationwide are tightening relationships with trusted, high performing post-acute providers and creating narrow networks to allow for increased collaboration and cost containment in the post-discharge period of the episode.
Remedy is helping providers prepare for the tidal wave of health care reform that is quickly escalating as CMS links reimbursement to quality and value, instead of quantity of services.
Through a rigorous evaluation process that includes both quantitative and qualitative elements, Remedy guides providers in the selection of the best centers for inclusion in the narrow network, through data collection and analysis. Skilled Nursing Facility Scorecards are created for each hospital’s market that inform the selection process.
Sheetal Shah, Director of Interoperability at Remedy Partners
Sheetal is responsible for projects related to partner integration and data exchange. Prior to Remedy Partners, she spent five years at the US Department of Health and Human Services with the Office of the National Coordinator for Health IT and the Center for Medicare and Medicaid Innovation. Her experience in health IT includes two years in Ethiopia leading the implementation of an administrative and clinical IT system at a university health center. She has an MPH degree in Health Policy from George Washington University and earned her undergraduate degree from the University of Michigan.
What led you to what you are doing now?
I think it was a combination of being in the right place at the right time and having the strong belief that everyone should have access to quality, affordable health care.
What is the biggest challenge in your job at Remedy?
We currently have a fragmented health care system and from my perspective the biggest challenge is: how do we build great, user-friendly tools to support value-based patient-centered care while also overcoming the social, legal, technical and policy issues related to exchanging health information among providers across the care continuum. I think we're experiencing a big culture change.
What do you think healthcare will look like in 2020?
I think we are going to see more health care at home. From a technology perspective, I think telehealth, social media and remote monitoring devices will play greater roles in supporting patients and their families.
What is the accomplishment at Remedy you are most proud of?
I am most proud of being a part of the team that has enabled Partners to access CARL via application programming interfaces (API). CARL is a tool that enables interdisciplinary team-based care and helps drive critical conversations during the discharge planning process. I think it’s so exciting that we now have the opportunity to help Partners use it for all patients in their electronic health record or other IT system.
What’s one thing you pursue in your non-work time?
There are two things I love: traveling and Netflix. Last summer I had a chance to visit Colombia and then I came back and binge-watched Narcos. Both were fantastic!
To be successful in this program, you will need to optimize your day-to-day workflow, ensuring that your patients receive better care at a lower cost. We at Remedy Partners believe that there are 6 Steps to Success.
Implementing a bundled payment program requires new knowledge, sophistication, and skills. In my healthcare career of 40 years focused on managed care and the hospitalist specialty, my work with Remedy and bundled payments again has me on a steep learning curve. Here I list my Top Ten “AHA” learnings at Remedy, in no particular order.
No matter what our role is in the healthcare system, we each want to contribute to improving the lives of those recovering from illness and seeking a return to health. The “glue” holding a well-run healthcare enterprise together, it strikes me, is invariably empathy. As we enter a new year, I’d like to reflect on a few practices I believe can enhance the empathy each of us naturally possesses, taken from an article I recently wrote.
Referring a patient to an acute care facility following major cardiac, joint, and spine surgery rather than the patient’s own home may not always be necessary, according to findings of a new self-examining study from NYU Langone Medical Center.
According to researchers, an approach to post-surgery care that the institution implemented two years ago—which included sharply reducing post-hospital referrals to acute care facilities—showed no corresponding increase in readmission rates. The study appears in the November 23 edition of JAMA Internal Medicine.