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Survey: Most Hospitals Unprepared for Orthopedic Bundled Payments

Data analysis is key

The Centers for Medicare and Medicaid Services (CMS) mandatory program of bundled payments for hip and knee joint replacements is set to take effect on April 1––whether hospitals are ready for it or not. And according to a new survey, most are not.

With its first mandatory initiative, the CMS has focused on one of its most expensive and common procedures:

  • More than 1 million hip and knee total joint replacement (TJR) surgeries take place in the U.S. each year.
  • Between 1997 and 2004, aggregate charges (the “national bill”) for primary TJR surgeries increased from $8.9 billion to $50.5 billion.
  • By 2030, the demand for total hip and knee replacements is projected to grow by 174% and 673%, respectively.
  • Individuals less than 65 years of age have shown the fastest TJR growth.

The new survey, conducted by Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR), found that, of more than 100 hospital orthopedic departments, 56% reported feeling unprepared for the new program, and only 10% reported feeling fully prepared. FORCE-TJR is a clinical registry at the University of Massachusetts Medical School.

The group has seen a surge of calls from hospitals interested in their services, which is what inspired the survey, according to principal investigator Patricia Franklin, MD.

“It occurred to us that people are doing their homework now, so they are probably not prepared,” she told HealthLeaders Media. Hospitals need to know that “this is coming, and it’s coming fast.”

Getting ready for the change requires health care centers to “amp up information systems to answer the cost and quality questions needed to manage well in this environment,” she said.

FORCE-TJR has tracked more than 25,000 patients and their surgeons who are already using an episode management system that includes data on patient-reported outcomes—one of three measures the CMS will use to assess quality. FORCE-TJR has offered to use its benchmarks to help hospitals assess their readiness for the new program.

The group has lots of competition, however. The changes brought about by the Patient Protection and Affordable Care Act have created an army of consultants willing to help hospitals figure out how to collect and analyze data, according to HealthLeaders Media. Those who offer help on dealing with bundled payments have taken to social media to tout their services, which come in the form of remote monitoring, podcasts, software, and webinars.

In the new survey, 75% of respondents said they were hiring staff. That makes sense, Franklin said, because they will need clinical nurse managers, transition coaches, or navigators who can track patients through the entire 90-day episode of care.

Data analysis is another key requirement for handling bundled payments, Franklin noted. Some integrated health systems will have the data infrastructure needed to track patients, to collect data, and to improve care––but some may not, so they had better get moving on it, she said.

Sources: HealthLeaders Media; March 10, 2016; and FORCE-TJR; February 29, 2016.

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