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Cardiovascular Rounds

News, resources, and analysis from the Cardiovascular Roundtable

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How is the two-midnight rule affecting your bottom line?

Brian Contos , Eric Fontana October 7, 2014

The two-midnight rule remains a top-of-mind issue for CV service lines. We recently analyzed its potential financial impact—and some providers have already reported significant decreases in inpatient cases and overall revenue declines due to the shift to lower paying outpatient status.

Yet the impact of the rule differs significantly based on a patient's diagnosis or procedure performed. For instance, the base rate Medicare outpatient payment for ICD implants actually exceeds the reimbursement for comparable, low-acuity inpatients. The same is true for cardiac ablation.

Read more »

The future of the two-midnight rule

July 9, 2014

Wondering what's in store for two-midnight? Looking for guidance on implementation? Then you'll want to check out a recent post from our colleagues at the Care Transformation Center. 

Our two-midnight experts responded to three frequently asked questions of late: 

1. What are the implications of CMS’s recent request for comments on potential short stays payment methodologies?
2. How likely is an adjustment to the 0.2% cut in payment that accompanied the initial finalization of the two-midnight rule?
3. Should I focus on compliance right now?

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Want a better picture of performance? Financial integration offers a panoramic shot.

May 27, 2014

Olivia Ley, Cardiovascular Roundtable

While financial integration requires an investment of time and resources, many programs are beginning to realize the substantial value of having a more holistic and transparent view of their performance. Some programs are integrating across specialties, while others are integrating across different sites of care beyond the hospital setting.

We’ve included examples of both below and shared how these programs are already starting to benefit from the results.

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The case for palliative care

May 1, 2014

Olivia Ley, Cardiovascular Roundtable

CV programs are starting to embrace palliative care as a means to improve quality and reduce costs—and they’re backed by some compelling evidence.

We've reviewed some of this research below, and offered guidance to help you integrate these services into your care continuum strategy.

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Findings from ACC 2014—and the resources you need to act on them

April 24, 2014

Andrew Hresko, Cardiovascular Roundtable

At the end of March, two of my colleagues from the Service Line Strategy Advisor program attended the American College of Cardiology’s annual meeting in Washington, D.C. They’ve written several blog posts about what was discussed, including the promising future for transcatheter aortic valve replacement (TAVR) efficiency and length of stay, the need for further investigation of renal denervation, the learning curve for radial PCI, and the future of aortic aneurysm care.

To help you act on findings from the conference, I’ve highlighted the Cardiovascular Roundtable’s available resources on a few of these topics.

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Before you bundle: Review episodic spending data for common CV conditions

Brian Maher April 14, 2014

Time and again, CV leaders have told us that bundled payments are challenging to implement. But during this year’s research, we isolated a common cause: participants are struggling to make sense of CV patients’ utilization and spending patterns once they leave the hospital.

So with our Data and Analytics Group, we’ve put together a new tool, the Episodic Cost Profiler, to help you estimate population-level spending patterns on select CV conditions and procedures.

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CV service distribution: The decision aids you need

April 7, 2014

Olivia Ley, Cardiovascular Roundtable

More and more CV leaders have to make challenging decisions about how to distribute services across sites. This not only means thinking more strategically about where and when to offer new services, but, in some cases, when it’s necessary to consolidate programs.

And while these decisions will never be easy, you have resources at your disposal that make them easier.

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One way to make discharge education stick: Group discharge sessions

March 19, 2014

Andrew Hresko, Cardiovascular Roundtable

CV leaders know that post-discharge self-management plans are crucial to avoiding readmissions. For more than a decade, studies have shown that discharge planning can reduce readmission risk for heart failure (HF) patients. But these plans are only effective when patients are willing and able to comply.

To make sure patients can adhere to these directions, programs must provide thorough education on self-management skills. However, education often becomes a “cram session” that occurs shortly before discharge, when patients and family are anxious and less able to process complex instructions.

Fortunately, you don’t need to revamp your entire discharge planning approach to make instructions stick. CV leaders at South Nassau Communities Hospital in Oceanside, N.Y., supplement traditional one-on-one bedside delivery with group HF education sessions.

Read more »

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