In today’s political environment, more Americans are turning a critical eye toward our health care system. The government, the media, our country’s health care workers, and everyday citizens are offering analysis, opinions, and proposed solutions for whatever problems (both perceived and real) they find to be plaguing the system.
One such solution, which has shown actual positive results right here at Hebrew Rehabilitation Center, is the Bundled Payments for Care Improvements (BPCI) initiative, developed by the Centers for Medicare and Medicaid Services (CMS) Innovation Center.
WHY IT’S NEEDED:
Historically, Medicare and Medicaid have made separate payments to health care providers for each illness or course of treatment faced by a patient. According to CMS, “This approach can result in fragmented care with minimal coordination across providers and health care settings. Payment rewards the quantity of services offered by providers rather than the quality of care furnished.”
In other words, services are costlier, less efficient, and worse for patients.
To help combat this issue, the Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models in hopes of reducing CMS costs while preserving or improving the quality of care. At Hebrew Rehabilitation Center, BPCI has done just that.
HOW IT WORKS:
For post-acute providers (skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals or home health agencies) care is “bundled” by “episode” rather than an itemized list of treatments. This episode begins as soon as the patient starts to receive post-acute services and lasts for a set amount of time, depending on the ailment. During this set period, the patient is the responsibility of the post-acute provider, whether they are being cared for at the post-acute facility or elsewhere. When the period of time for that episode has ended, the patient’s care costs are reconciled against a predetermined rate per episode. If the costs were lower than the predetermined rate, CMS and the care provider share the savings.
This potentially puts money back into the hands of CMS (which is good for taxpayers) and gives the care provider an incentive to provide the best quality care possible, not just the most care possible. Providers are incentivized to cut down on wasteful over treatment while still keeping patients as healthy as possible.
Here is an example: If Mary - a knee replacement patient - becomes sick with pneumonia during her 30-day episode and must go back to the hospital, she is still the responsibility of the rehab center, even though she is no longer under their roof. This ensures that rehab center works efficiently and effectively to keep Mary in the best health possible, without drawing out her stay or over treating her ailments.
For Hebrew Rehabilitation Center (HRC) the results of this initiative could not have been better. In the year since this program has started, HRC has saved Medicare $1.2 Million. Having only 98 beds, this is quite a feat. More importantly, efficiency has improved while retaining and even improving the quality of patient care. The average length of stay per patient has dropped by three days, while patient satisfaction rates are the highest ever recorded.
Clinicians at HRC attribute these results to better communication all around, and a feeling of ownership for each patient – from before they come through the door, until long after they go home. HRC case managers are coordinating with the acute care hospitals before the patient arrives, communicating with families and home-care providers about discharge needs from day one, and working with patients toward their goals throughout their entire episode of care.
Brian Murphy, Senior Director of Admissions and Referral Services at HRC put it best when he said, “We’re more efficient, we create better relationships, and we help patients reach their goals (usually getting home faster) by changing the way care is delivered. It’s in everyone’s best interest to get it right.”
About Hebrew Rehabilitation Center in Boston and Dedham
At Hebrew Rehabilitation Center (HRC) our long-term chronic care hospital license allows us to offer comprehensive medical programs and therapies that meet the special needs of older adult patients. We understand the important role families play in our patients’ care and view each patient as an individual with a unique set of goals for care. We offer a long-term chronic care program, a medically acute care program and outpatient rehabilitative and specialty therapies. Our post-acute Rehabilitative Services Unit is also located at both HRC locations.