Would love to gain a perspective on the implications of how the condition specific comprehensive care model might fit N of the border?
From another perspective, 'who best in charge', Ortho Surg Team incorporating PT and PC providers, or a mix the other way, based in PC? Perhaps room for both?
In theory, anyone COULD be in charge. I'm obviously biased, but I think specialty care is best driven by specialists. Of course, if we're not willing to embrace a more comprehensive model, that opens things up for others. Care coordination is possible between disparate entities, but I think an integrated model is best. Current CINs have been a mixed bag. That's why I favor a specialty focused medical home model.
1) Much of the drive to cost containment, such as minimizing SNF use, moving to ASCs, were pushed by CMS value based care models where Surgeon's saw the benefit to gaining more revenue on the upside, not because of Surgeon's drive to maintain cost control. If it were the latter, it would have happened much earlier.
2) The Newsweek article seems like a bit of a promo piece for their America's Best Surgeons material.
Thanks for your comments. Can't disagree with the second point!
However, I disagree with your first point a bit. SNF use is probably the #1 cost driver for joint replacements in the episode of care. The trend away from SNFs started before programs like CJR and BPCI in part due to studies showing that discharge to a location other than home is associated with increased complications and readmission rates. Plus, a lot of patients do not like going to these facilities. CMS VBC programs may have accelerated the trend, but it was well underway beforehand. ASC use has been less driven by CMS programs and more driven by declining reimbursement, studies showing it is a safe and cost-effective option for many patients, and the pandemic. CMS was a little late to the game removing TKA and THA from the inpatient only list, and a smaller percentage of Medicare patients are medically appropriate for an ASC (compared to commercially insured patients).
The CMS VBC programs absolutely deserve credit for teaching us enduring lessons about patient optimization, risk reduction, reducing use of expensive/unnecessary post-acute care where appropriate, and the importance of a team-based approach. These lessons endure even if/when surgeons drop out of these prorgrams.
With re: to SNF utilization, I don't question the benefits of patient's going home after an elective joint replacement versus SNF. However, I noticed this shift primarily occurring after our Hospital CEO met with us in conjunction with a BPCI convener, then known as Remedy Partners, pointing out how expensive SNF stays were and asking why they couldn't be reduced. SNF discharges for elective knees and hips were then dramatically, and rightfully, reduced.
Great discussion Ben, thank you.
Would love to gain a perspective on the implications of how the condition specific comprehensive care model might fit N of the border?
From another perspective, 'who best in charge', Ortho Surg Team incorporating PT and PC providers, or a mix the other way, based in PC? Perhaps room for both?
In theory, anyone COULD be in charge. I'm obviously biased, but I think specialty care is best driven by specialists. Of course, if we're not willing to embrace a more comprehensive model, that opens things up for others. Care coordination is possible between disparate entities, but I think an integrated model is best. Current CINs have been a mixed bag. That's why I favor a specialty focused medical home model.
Nice intro with many valid points but:
1) Much of the drive to cost containment, such as minimizing SNF use, moving to ASCs, were pushed by CMS value based care models where Surgeon's saw the benefit to gaining more revenue on the upside, not because of Surgeon's drive to maintain cost control. If it were the latter, it would have happened much earlier.
2) The Newsweek article seems like a bit of a promo piece for their America's Best Surgeons material.
Thanks for your comments. Can't disagree with the second point!
However, I disagree with your first point a bit. SNF use is probably the #1 cost driver for joint replacements in the episode of care. The trend away from SNFs started before programs like CJR and BPCI in part due to studies showing that discharge to a location other than home is associated with increased complications and readmission rates. Plus, a lot of patients do not like going to these facilities. CMS VBC programs may have accelerated the trend, but it was well underway beforehand. ASC use has been less driven by CMS programs and more driven by declining reimbursement, studies showing it is a safe and cost-effective option for many patients, and the pandemic. CMS was a little late to the game removing TKA and THA from the inpatient only list, and a smaller percentage of Medicare patients are medically appropriate for an ASC (compared to commercially insured patients).
The CMS VBC programs absolutely deserve credit for teaching us enduring lessons about patient optimization, risk reduction, reducing use of expensive/unnecessary post-acute care where appropriate, and the importance of a team-based approach. These lessons endure even if/when surgeons drop out of these prorgrams.
Thanks for the reply!
With re: to SNF utilization, I don't question the benefits of patient's going home after an elective joint replacement versus SNF. However, I noticed this shift primarily occurring after our Hospital CEO met with us in conjunction with a BPCI convener, then known as Remedy Partners, pointing out how expensive SNF stays were and asking why they couldn't be reduced. SNF discharges for elective knees and hips were then dramatically, and rightfully, reduced.