When hospitals enter into the bundled payment world, they become responsible for the cost of an entire episode of care — including what happens both before and after the actual care intervention, such as patient preparation and care provided beyond their own four walls.
Communication with various stakeholders was a major part of a panel discussion on implementing care bundles at the Becker's Hospital Review 6th Annual Meeting May 7 in Chicago. Moderated by Michael Wolford, a manager in the strategy market for DHG Healthcare, the panelists were:
- Denise McGinley, RN, service line director for the Center of Orthopaedic Innovation at St. Luke's Medical Center (Phoenix) and Tempe (Ariz.) St. Luke's Hospital
- Kristen Yntema, the vice president of regional development and innovation for Advanced Home Care, and
- Margie Zeglen, the director of bundled payments, business development and planning for Palos (Ill.) Community Hospital
Since most bundles make provider organizations responsible for a 90-day period of care, that represents a major change in thinking for many providers who are used to simply treating and releasing a patient.
Advanced Home Care is participating in the BPCI Model 3 in three 90-day bundles: chronic obstructive pulmonary disease, congestive heart failure and pneumonia. However, Ms. Yntema noted that a typical patient for her organization was 40-45 days. "We're learning that we have opportunities there…and what to do in days 45-90," she said.
Ms. McGinley's organization is also learning about what to do in that new 90-day period of responsibility. Her organization is participating in BPCI Model 2 in the major joint replacement of the lower extremity 90-day bundle. Ms. McGinley is working to "knock down the wall of surgical tunnel vision" and get surgeons to own the patient for the full 90 days. When surgeons start thinking about a patient from start to finish and communicating with them before and after surgery, it can reduce readmissions and improve outcomes.
In addition to changing how surgeons think about their patients and communicating more with them, healthcare organizations in the same area also need to communicate with each other. "What I've learned is everything is better when you talk to people," Ms. McGinley said. "We are much tighter in terms of relationships in the healthcare community than we ever were before" since implementing bundled payments.
Ms. Zeglen agreed with that sentiment. "The most valuable thing we've learned is you have to communicate," she said. Her organization is also in BPCI Model 2 90-day bundle for major joint replacement of the lower extremity and is learning that patient communication is critical. Now, when a patient is scheduled for surgery, someone from Palos Community Hospital reaches out. Staff also extensively goes over a discharge planning checklist to make sure patients understand what they need to do to avoid a readmission.
Additionally, communicating with outside providers has also been helpful for Ms. Zeglen and Palos' program. She has found that post-acute care providers are "interested in working with us and meeting the expectations…of the program."