CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016
Agenda Collaborative Learnings HF Correlation to AMI and CABG Bundled Payments CMS AMI & CABG Bundled Payment Programs Survey Background AMI & CABG Success Factors and Areas of Opportunity Discussion Bundled Payment Background AMI & CABG and HF Relationship Survey Objectives Target Audience The Key Success Factors Main Obstacles and Opportunities for Improvement How to leverage collaborative work to prepare for management of AMI & CABG bundled payments
Collaborative Learnings Care Team Coordination Using process mapping to standardize care HF Collaborative Patient Stratification Identifying and managing high risk patients AMI & CABG Bundled Payments Medication Management Communicating about medication changes
AMI & CABG Bundled Payments Deadline for Proposed Rule Comments October 2016 Final Rule Publication and MSAs Announced Late 2016/Early 2017 First Performance Period Ends December 31, 2017 July 2016 AMI & CABG Bundled Payment Announced TODAY July 1, 2017 First Performance Period Begins About the Bundle 90-day episode of care Retrospective with annual reconciliation Participants are 98 randomly selected MSAs Payment for Quality CMS is offering an incentive for cardiac rehab services post-discharge Impact on MACRA participation Included MS-DRGs CABG 231-236 AMI 280-282 PCI 246-251 with an AMI ICD-10 principal or secondary diagnosis code Measurement Categories Length of Stay Readmission Rates Mortality Rates Patient Satisfaction Rates
Bundled Payment Survey A non-scientific study designed to provide directional information on how we might use the learning/best practices from the HF collaborative to succeed in the CABG/AMI bundles Survey Background Distributed from November 18- December 1 Survey objectives: Identify potential barriers to implementing bundled payment programs Determine the necessary resources to be successful in procedure and event-based bundled payments Assess bundled payments performance readiness Define opportunities to support heart failure management within cardiac bundle payment implementation Survey Participants Targeted participants: Nation-wide providers at integrated delivery networks MD or PharmD credentials were primary respondents Participant s Role Specialty Care Physician Specialty Care Physician Physician Extender Physician Assistant, NP, Nurse Midwife, APN, etc. PharmD or pharmacy assistant Practice Management Management; Practice Manager, Office manager Other (please specify) Other* *Other: Primary Care in leadership position: C-Suite, Executive Clinical Council, Medical Director, Clinical Care Coordinator
Bundled Payment Performance Current Bundled Payment Performance Includes BPCI and CCJR 100% believe they have room for improvement, but also acknowledge that they are doing well 55% of respondents are currently participating in bundled payment programs How do respondents categorize their organization's potential performance? Excellent Very good, but with room for improvement Good, but still some work to do Unsatisfactory, but making progress Poor Very Good vs. Good -> Differentiating factor is extent of program infrastructure
Success Factors: What do those responding very good have in common? C ommon B e s t Practices Service Line Structure Integrated Service Lines and Care Teams: Primary Care, Pharmacists and Quality Departments Transition of care discharge services: Pharmacy-based clinics (Coumadin, etc.) Home health Post-acute management and rehab Tele-medicine: Only 50% of respondents have tele-monitoring resources Bundled Payment Implementation Teams Designated Implementation Teams: 100% of those with a bundled payment implementation team feel they are performing very well with some room for improvement Streamlined Processes: Either an AMI or CABG pathway developed; pathways include system formulary preferences
Areas of Opportunity Post-Discharge Care Coordination Standardized Clinical Workflows What did respondents identify as the biggest barriers to implementing AMI and CABG bundled payment programs? Staff Education
Post-Discharge Care Coordination Expand Collaboration with Discharge Destinations Cardiac Rehab Primary Care Post-Discharge Care Coordination Standardized Clinical Workflows Staff Education Home Care Post-Acute Facilities The majority of a patient s costs are after discharge Over 60% identified patient access to post discharge services as a barrier Opportunities to expand: Pharmacy integration Tele-monitoring Coordination for Post-Discharge care
Standardized Clinical Workflows Post-Discharge Care Coordination What do you see as potential barriers to implementing AMI and CABG bundled payments at your organization? 50% Resistance to standardization of care Standardized Clinical Workflows Staff Education Expect clinical pathways to change 85% plan on exploring clinical workflow process improvements through the AMI and CABG bundled payment initiative Other bundled payment programs show key steps are: Identifying patients Conducting risk stratification Determining appropriate discharge destination Establishing care coordination and transitioning care teams
Staff Education Bundled payment topics for staff education missing in respondents health systems Clinical workflow training Post-Discharge Care Coordination Impact of bundled payments Utilizing quality reports: Interpreting and acting on results Standardized Clinical Workflows Staff Education 0% 10% 20% 30% 40% 50% 60% Develop necessary quality reports and educate staff on responsibilities and appropriate follow-up actions CMS plans to monitor: Length of Stay Readmission Rates Mortality Rates Patient Satisfaction Rates The culture of transparent reporting
Bringing It All Together Everyone has challenges with bundled payment programs Keys to success include: Designating a care team to manage bundled payments Increasing access and management of post-discharge services Streamlining workflows, consider: Early identification of patients A process for stratifying risk Discharge coordination Incorporate primary care, quality departments, and pharmacy Monitor patients adherence, based on assessed clinical risk Providing education about quality reports, bundled payment impacts, and clinical workflows What s Next: As you continue to implement changes from the HF collaborative, think about how you can incorporate initiatives supporting AMI and CABG
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