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Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign
Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign
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A desire to position itself at the forefront of healthcare payment reform and be a catalyst for clinical redesign are two factors driving Brooks Rehabilitation's participation in Model 3 of CMS's Bundled Payments for Care Improvement (BPCI) initiative.

Today, having completed more than 1,000 bundled episodes for total hip replacements, total knee replacements and hip fractures, Brooks has reduced cost by 19 percent per episode, lowered readmissions to about 15 percent across its 60-day time frame, registered a patient satisfaction level of 94 percent and documented significant functional improvement.

Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign examines the four domains of success of Brooks' Complete Care program supporting the organization's bundled payment clinical outcomes and financial results.

In this 25-page resource, Debbie Reber, MHS, OTR, vice president of clinical services, Brooks Rehabilitation, shares the inside details of Brooks' Complete Care program and the resulting, significant savings Brooks achieved through CMS's BPCI Model 3, which is limited to retrospective post-acute care (PAC) for select diagnosis-related groups (DRGs).

Model 3 includes all non-hospice Part A and B services during the post-acute period as well as readmissions.

Ms. Reber shares the following details:

  • Opportunities for post-acute care to succeed in bundled payments;
  • An overview of the Brooks Rehabilitation system, including an acute inpatient rehabilitation hospital, skilled nursing facilities (SNF), home health, multiple outpatient clinics, and an assisted living facility;
  • The scope of PAC responsibility within BPCI Model 3 and Brooks' bundled payment history since October 2013;
  • Insights into PAC readmissions and their relationship to initial acute episodes;
  • The four core domains central to Brooks' Complete Care and program elements within each domain;
  • Tools and educational materials for engaging and activating PAC patients and enlisting caregiver support, including the Patient Activation Measure (PAM)®;
  • A look inside Care Compass, Brooks' patient data warehouse, which houses a longitudinal care plan, patient engagement tools, PAM scores, and reports and analytics—tools that enhance care transitions and foster Brooks' whole-person approach to care;
  • How Brooks Rehabilitation will leverage its two years of bundled payment experience for participation in CMS's newly announced Bundled Payments for Joint Replacements program;
  • Lessons learned and performance improvement goals;
And much more.

Table of Contents

  • Bundled Payments for Post-Acute Care: Four Critical Paths To Success
    • Overview: Brooks System of Care
    • The Post-Acute Care Opportunity
    • Rationale for PAC Participation in Bundled Payments
    • Brooks Bundled Payment Participation
    • 4 Domains of Clinical Program Design
    • Longitudinal Care Plan
    • Patient Engagement and Activation
    • Data Analytics and Technology Solutions
    • Challenges for Better PAC Management
  • Q&A: Ask the Expert
    • Readmissions Challenges in Post-Acute Care
    • The Longitudinal Care Plan Tool
    • Tools to Engage PAC Patients
    • Defining Care Navigator and Case Manager Roles
    • Convener Use
    • ER Alerts
    • Assuming Risk for LTACH Admissions
    • Notice of Bundled Payment Patients
    • Obtaining DRGs for PAC Patients
    • Communication during Care Transitions
    • Key Metrics for Compass Tool
    • Leveraging Bundled Payment Experience for CMS’s New Joint Replacement Program
    • Standardized Assessment Tools
    • Following Patients in Non-Brooks Care Settings
  • Glossary
  • For More Information
  • About the Contributor
Publication Date: September 2015
Number of Pages: 25
ISBN 10: 1-941329-90-X (Print version); 1-941329-91-8 (PDF version)
ISBN 13: 978-1-941329-90-0 (Print version); 978-1-941329-91-7 (PDF version)
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