A.G. Gancarski
Florida may be resistant to the charms of the Affordable Care Act on a governmental level, but hospitals such as Jacksonville’s Brooks Rehabilitation benefit from certain components of the ACA: specifically, bundled payments.
Much focus has been given to the dysfunctions of the ACA. But Tuesday in Jacksonville, health care providers painted a rosy picture of one aspect of this program.
With that in mind, U.S. Department of Health and Human Services Secretary Sylvia Burwell was in Jacksonville Tuesday to host a roundtable about that facility’s participation in Bundled Payments, an Affordable Care Act program.
Expanded this week, said Burwell, cardiac rehab bundled payments to facilitate “overall alignment.”
So far, Brooks has served 2,500 patients under the program, which allows for what Brooks calls “accountability” for 30- or 60-day episodes of care for issues including hip fractures, joint replacements, heart failure, and spinal surgery.
Costs have been cut by 20 percent. Hospital readmission rates are down, including 24 percent for hip and knee replacements. And customer satisfaction is at 95 percent.
Among those on hand with Burwell, attesting to the efficacy of bundled payments were Pat Geraghty, the chairman and CEO of Florida Blue and Doug Baer, the CEO of Brooks Rehabilitation, along with patients, caregivers, and medical professionals and executives of various types.
Brooks opted into the ACA program because they thought that’s where healthcare was moving, Baer said, toward a “structure that rewards quality of care over quantity of care.”
Burwell noted this event was about “better, smarter healthcare,” adding that the Affordable Care Act was intended to provide access to quality, and that currently the U.S. has the lowest uninsured rate in history.
This allows, Burwell said, for preventive care, which reduces the number of things that go wrong in a health care setting.
The goal of this event: discussion of how to go forward.
Changing the way payment is rendered, which Brooks exemplifies with bundled payments, is an example of “encouraging the type of care that providers want to practice,” Burwell said.
That change leads, Burwell added, to consumer empowerment.
Baer noted that Brooks is participating in a “post-acute bundle.” After almost three years in the program, Baer calls it “transformational,” having changed the way Brooks looks at care into a more “holistic” view.
“We’ve been able to have great outcomes … reduced hospital re-admissions … saved costs,” Baer said, adding that Brooks wants to expand the modality to non-bundled populations.
Three years ago, the program was a “blank piece of paper,” said Mike Spigel, the president of Brooks.
“There’s still many ways to improve care,” Spigel noted, and “bundled payments” have been a key to that process.
Also boosted: the use of data to change behaviors, related to “transition points” such as changing from in-house to home care and medication reconciliation to ensure patients have understanding of the medicines they are supposed to take and how they might interact with one another.
This can ease the transition from acute care to post-acute care, said Dana Pedrick, a case management director for St. Mary’s Langhorne.
Brooks’ orthopedic director, Howard Weiss, was a bundled care skeptic who has been converted, saying that “communication” can make the difference between a good outcome and a bad outcome, related to medication and other aspects of treatment.
“My patients are doing better,” Weiss said, based on communication from “care navigators.”
Burwell noted overcoming skepticism is a key to program success, and Weiss concurred, saying the best way to understand is for recalcitrant medical professionals to see what Brooks and other bundled payment health providers use.
Geraghty noted that a “fee-for-service system is designed for volume,” adding that a “higher quality service” should get reimbursed, as “quality health care is more cost-effective.”
Burwell noted that working with the private sector is intended to improve outcomes.
“We cannot do this in isolation,” noted Omar Ishrak, CEO of Medtronic.
“Bundling raises awareness of providers for the costs of health care,” said cardiovascular surgeon Jeff Rich, who said the program created “awareness on [his] part of things [he’d] never thought of before.”
Accountability, Rich said, is the key.
“Bundling pulls it all together. It accelerates exciting discussions, and the bundling makes those conversations to help [patients] along the way,” Rich added.
There are gaps, said Bill Kramer of the Pacific Business Group, including on the patient-outcome side, to get regular communication to patients on what they are able to do in rehab, to supplement traditional clinical information.
“The clinical world and the business world gets a little jaded about whether the consumer really knows,” added Geraghty.
“Health care is still delivered locally. And it’s different in every community,” Geraghty said, citing differences in markets.
“Quality measures” can work toward meaningful standardization, Geraghty added.
Burwell noted implementation of this concept is “relatively new,” but HHS hopes that in five years, this will be a much more common conversation.
“This conversation cuts across everyone,” Burwell added.
