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Cardiovascular Rounds

News, resources, and analysis from the Cardiovascular Roundtable

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Would you be my (medical home) neighbor?

October 8, 2014

Just last month, the National Committee for Quality Assurance (NCQA) recognized the 8,000th patient-centered medical home – and that’s just the number of medical homes that are formally recognized, not including the many that operate without formal recognition. The role of primary care is emphasized in many of the care transformation efforts, such as medical homes and ACOs.

In fact, our colleagues over on the Medical Group Strategy Council just posted a great blog explaining the difference between a number of these clinical care redesign efforts, including the patient-centered medical home model.

However, the increasing popularity of these primary care-focused entities has left a lot of our members wondering “What is CV’s role in primary care redesign?”

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

by Jeffrey Rakover and 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.

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Pick the right risk stratification tools for your CV program

May 5, 2014

Andrew Hresko, Cardiovascular Roundtable

In our study Blueprint for Cardiovascular Care Management, we stress the importance of using risk stratification to pair patients with appropriate clinical and non-clinical providers and to determine the intensity and frequency of follow-up care. This targeted approach will not only help optimize clinical care, but also enable more efficient use of limited resources.

While risk stratification is a powerful strategy, the reality is that no existing tool is perfect. There are many classes of tools that assess different nuanced aspects of patients’ well-being and ideal care plans, and within each of those classes there is a multitude of tools that rely on slightly different metrics. The best risk stratification strategies often involve some combination of available models.

To help you begin to weed through your options and select the best suite of risk stratification tools for your CV care management program, I’ve provided a list of links to some of the most commonly used, publicly available care management risk stratification tools.

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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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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.

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How to track performance under risk-based contracts

February 28, 2014

Jeffrey Rakover, Cardiovascular Roundtable

As more and more CV providers take on risk-based payment, you need to start thinking about how to track performance against these contracts. The challenge is selecting metrics that you can use across payers, contracts, and time—particularly during and after the hospital stay. While providers can’t necessarily change conflicting reporting responsibilities in the near term, they can select high-value metrics to drive overall success.

Fortunately, you have some great examples to follow. Sparks Health and Maine Heart both saw significant performance improvement after updating their dashboards of CV performance metrics, specifically in the context of bundled payment models. Here’s a look at what they include.

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How (and why) to develop a cardio-oncology partnership

January 10, 2014

Andrew Hresko, Cardiovascular Roundtable

Cardiovascular Business recently published an article exploring the emerging field of cardio-oncology, which developed from the apparent relationship between cancer treatment and cardiomyopathy. Cardiologists and oncologists alike have begun creating protocols to screen cancer survivors for developing heart problems—and some are even pursuing multidisciplinary collaborations to care for the diseases jointly.

During our national meeting research, we found that several institutions are placing a new emphasis on improving care for these complex patients through cross-service line cardio-oncology collaborations.

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The CV care management dictionary

December 9, 2013

Andrew Hresko, Cardiovascular Roundtable

At our national meeting, we begin our CV care management presentation with a complicated word cloud and two big questions: What do all these new terms about patient care mean? Are they just catchy buzzwords?

Care management jargon certainly can be confusing. But parsing out the nuances between the often similar-in-name and related-in-function terms is an important step in developing a coordinated CV care management strategy. We’ve defined some of these complicated terms below to provide some clarity and identify the relationships between them.

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