It will not be news to any reader of Lab Soft News that our healthcare system is highly fragmented and often provides inadequate continuity of care. CMS is trying to help solve this problem, at least for post-acute cardiac care patients (see: Hospitals will pivot to post-acute care to thrive under cardiac bundles). This new initiative was detailed in a recent article, an excerpt from which is provided below:
In the days and months after a heart attack, a patient has a long list of tasks to remember as they recover: Take medications, eat nutritious foods, go to physical therapy, to name just a few. This kind of post-acute care has long been viewed as outside the purview of the hospitals that treated the patient in the first place. But a new set of rules for cardiac bundled payments and rehabilitation, proposed ...by the CMS, is likely to drive hospitals to pay far more attention to post-acute care, a shift that could pose fresh challenges in a healthcare system that in many ways remains disjointed....Under a proposed demonstration program that would start July 1 next year in 98 randomly selected areas, Medicare would pay hospitals under a bundled-payment model for coronary bypass surgery and treatment for heart attacks. The hospitals would get a set amount per medical episode to cover the hospitalization and all of the related care for 90 days after the patient is discharged. That puts hospitals at financial risk for managing the quality and efficiency of care delivered by a variety of post-acute providers, including skilled nursing and rehabilitation facilities and home health agencies.....For NYU Langone, that meant creating new lines of communication—among physicians, nursing facilities, physical therapists, other providers—that hadn't previously existed. The hospital developed a transfer document that everyone reviewed regularly for status updates on a patient. With better post-acute care, treatment costs could be slashed by anywhere from 10% to 20%.... [T]he structure of the CMS' proposed cardiac bundled payment would push hospitals and physicians to be proactive. As bundled payment programs have expanded, major hospitals started to implement programs to track patients' discharge and recovery....Now...hospitals have an increasingly robust array of incentives to get serious about follow-up care. But deeper involvement in post-acute care won't necessarily be easy or smooth for hospitals, however. They might be located in areas that have a dearth of high-quality post-acute care providers....
To quickly summarize, Medicare is testing a bundled-payment model for coronary bypass surgery and treatment for heart attacks patients in 98 randomly selected areas. The hospitals would get a set amount per medical episode to cover the hospitalization and all of the related care for 90 days after the patient is discharged. This will force hospitals to track, and also take some responsibility, for post-acute cardiac care in other facilities. If low quality results are obtained, it would jeopardize the hospitals' payment for acute care.
Long overdue is this attention by CMS to post-acute cardiac care. CABG patients, for example, may now be discharged from hospitals with only a handshake. Cardiac rehabilitation and the emphasis on required lifestyle changes may be left to chance. This new Medicare initiative, as the article above states, requires the development of "new lines of communication—among physicians, nursing facilities, physical therapists, other providers—that hadn't previously existed." I suspect that some hospitals, in the long run, may decide that all of this new paperwork will not be worth it and begin to insource some of the post-acute services that they were previously happy to cede to other providers.