Joining Medicare’s Bundled Payments for Care Improvement Initiative (BPCI) pilot project was a matter of jumping on a train that was already leaving the station, says Amy LaFleur, Vice President of Operations with Trinity Senior Living Communities.
“It’s work you have to do anyway, if you’re going to survive in a fee-for-value world,” LaFleur says. “So you can do the work now as part of the pilot program, or you can defer it.”
Last year, 12 Trinity Health skilled nursing facilities and three home health agencies entered the risk-bearing phase of BPCI Model 3, a voluntary bundled-payment program for post-acute care providers. More than 30 Trinity Health hospitals entered BPCI Model 2, which includes both acute and post-acute care. (For more on Trinity Health’s experiences with BPCI, see Bundled Payments Are Coming: Will You Be Ready?)
In a recent interview with Plante Moran, LaFleur shared takeaways from Trinity Senior Living’s first quarter results.
The results
Results from its first quarter in the program (April-June 2015) reinforce that bundling was a smart gamble for Trinity Senior Living.
Out of the 239 episodes for which Trinity Senior Living was the “facilitating convener,” the overall performance across the 14 major diagnostic categories resulted in positive reconciliations.
As a result, in February 2016 the organization experienced a bump in revenue associated with its positive performance in the CMS program during Q2 2015. (The reconciliation process takes about 6 months.) The main factors contributing to that success were:
- Driving down average lengths of stay (LOS) by about three days from the baseline period (2009-2012).
- Shaving hospital readmission rates by about 3% for Trinity Health skilled nursing facilities and 2% across an entire 90-day episode.
How they did it
To achieve those results, Trinity Senior Living took the following steps:
- Stratify risk. A proprietary tool identifies patients who are high risk for hospital readmission and spells out a directed plan of care.
- Evaluate care pathways. Specific milestones for improvement—for example, the patient will be able to walk with assistance within 2-3 days—provide a framework to help patients and caregivers achieve LOS targets.
- First day home. Patients discharged from Trinity Health SNFs receive a phone call on the first day home and a nurse visit within 24 hours.
- Manage medication. A pharmacist performs medication reconciliation for any patient taking multiple meds.
- Narrow the network. A dashboard demonstrates how home health agencies are performing on standards such as first-day home visits. Trinity Health jettisons relationships with agencies that don’t meet its standards.
Stay the course
Bundled payments are not for the risk-averse. LaFleur urges providers to have the patience to wait out the inevitable rough quarters with an eye on the end game—positioning the organization to manage the health and wellbeing of its constituencies.
“Having enough of a stomach for risk is pretty important. If you’re confident that you have an upside from your baseline numbers, you have to stay with it.”
