In a discussion held at the National ACO, Bundled Payment and MACRA Summit, panel members reviewed several keys to success when navigating the Comprehensive Care for Joint Replacement and bundle payment models.
One of the keys to success in the Comprehensive Care for Joint Replacement (CJR) is that an organization has executive-level buy-in and corporate sponsorship, according to the panel members.
“I think one of the critical things for success, and even for a requirement for us to work with an organization, is that they have executive-level buy-in throughout the organization to actually go and do this,” David Terry, MBA, founder and CEO of Archway Health, said.
Terry added that both the doctors and members of the organization need to be engaged in the program, while Lana Smith, MSN Nursing, corporate director at Service Lines at Adventist Health, noted everyone involved in the program should be educated on the CJR.
“I am a nurse so as I worked with all of the clinicians throughout the hospital, I had to dispel some of the negativism and get down to what bundled payments was all about,” Smith said. “We had to do a lot of education.”
From a clinical aspect, Will Hahn, MBA, director of strategy and business development at Sutter Health, said success also lies in patient selection, as well as identifying the best physicians to engage in the program. Following a governance model may also prove to be beneficial, according to Hahn.
“[It’s] getting the right people at the table to not just understand the program, but to drive implementation of the program,” Hahn said.
Smith noted one strategy her group is mandating in its outpatient clinics includes monitoring patient factors, including BMI of less than 40kg/m2; an A1c of less than 8 if the patient is diabetic; mandated education and smoking cessation; to see how these factors relate to readmission, complications, length of stay and infection in a bundle payment model.
“We have already lowered ... infections significantly by 53% from last year to this year just by implementing our bundle and mandating that,” Smith said.
Although education, consistency, good project management, identifying key physicians to engage and spreading best practices are all areas that can lead to success, she said mandating practices can make a difference.
“We learned that not having the option to opt in or opt out is not necessarily good,” Smith said. “There are things that promote excellent care from mandating certain things.” – by Casey Tingle
Mini-summit XIV: Lessons learned from CJR. Presented at: The National ACO, Bundled Payment and MACRA Summit; June 6-8, 2018; Washington, D.C.
Disclosures: Orthopedics Today was unable to obtain relevant financial disclosures at the time of publication.