NEWPORT BEACH, Calif. — Readmissions and length of stay at a skilled nursing facilities are significant cost drivers in new payment models, according to a speaker at the Interdisciplinary Conference on Orthopedic Value-Based Care.
“The piece of your 90-day bundle, depending on what program you are in, varies significantly. [On average,] major joint replacement of the lower extremity is about 44% of the average spending across the United States,” Kelly C. Price said here.
A few things Price believes post-acute care providers should know about new payment models are that all of the spending variation is in the post-acute setting; measures for patient recovery or outcomes do not currently exist; readmissions are a significant cost driver; inpatient rehabilitation facilities are the most expensive driver in the post-acute care setting; skilled nursing facility (SNF) length of stay is another significant cost driver; new payment models provide opportunities for non-conventional strategies; and surgeons should know their value.
“In particular, inpatient rehabilitation facilities have taken a big hit in the last few years. If you were to look at the average price of a bundle, total spending for patients who are sent to specific types of post-acute settings is significantly more expensive than [SNFs, self-care and home health agency] settings,” she said.
The major problem is there is no way to quantify whether patients who are sent to inpatient rehabilitation facilities come out in better condition and have better quality of life, Price noted.
According to Price, readmission alone adds expense. Post-acute spending for patients with a readmission tends to be higher, she said, noting almost all readmissions after joint replacements are preventable.
“When you are talking to your post-acute providers, show them all the things you are looking at; show them what you are up against; show them what the spend is for that particular provider compared to other types of providers in the area. Just start the conversation. They are much more willing to talk than they have been in the past, and as long as you keep the conversation simple, they will either come around or they will fall out of your preferred network,” Price said. - by Nhu Te, MS
Price K. Post-acute care in the world of bundling. Presented at: Interdisciplinary Conference on Orthopedic Value-Based Care; Jan. 20-22; Newport Beach, Calif.
Disclosure: Price reports she is the vice president and chief of health care analytics at DataGen.