As we discussed in our recent Geriatrics Services Strategy webconference, hospitals can choose from a variety of programs—both formal and informal—to elevate specialized services for the elderly, improve outcomes, and improve margins. During the call, we received a question regarding geriatric fracture programs, and we wanted to provide more information here in follow-up.
Hospitals establish geriatric fracture programs to ensure that patients receive timely, high quality care for a range of fractures. Elderly patients commonly suffer from weakened (osteoporotic) bones, leaving them more frail and susceptible to a range of fractures, particularly hip fractures, but also arm, foot, etc. According to HCUP data, over half (54%) of patients receiving inpatient care for fractures are age 65 or older. Among hip fracture patients, the proportion that are elderly rises to 87%. Geriatric fracture programs bring together orthopedists, geriatricians, and other providers who specialize in treating fractures in elderly, frail patients. Clinical studies suggest that such collaboration may improve outcomes for fracture patients.
Facilitating multidisciplinary care, growing brand through formalized geriatric fracture programs
An acute care of the elderly (ACE) unit is traditionally structured as a dedicated space and interdisciplinary team for addressing the complex care needs of elderly patients in the hospital. The University Hospitals of Cleveland originally established this type of unit and other organizations, like Nurses Improving Care for Healthsystem Elders (NICHE), have since adopted and adapted the concept to fit their needs.
The ACE unit concept includes dedicated units that provide care for the numerous conditions that typically afflict elderly patients. The goal of ACE units is to prevent or mitigate functional decline in elderly inpatients. At the same time, ACE units centralize expertise for geriatric interventions, particularly in service areas such as orthopedics, cardiology, and urology, and incontinence. ACE units provide care in spaces outfitted with amenities that are especially beneficial to older patients, such as rooms with more lighting and materials in large print type, among other adaptations that increase patients’ comfort level.
Considerations for ACE unit adoption
Among the payment reforms under consideration by CMS and private payers, a methodology known as bundled payment has gained traction. Bundled payment programs seek to address one weakness of the fee-for-service payment system -- that physicians face little accountability for the cost of hospital-based patient therapy or care. Physicians consider cost less often than would be desirable when making cost-related decisions, such as which implant to use or when to discharge patients. Traditionally, hospitals cannot legally reward physicians for reducing costs associated with inpatient care.
However, the Center for Medicare and Medicaid Innovation (CMMI) recently released a bundled payment program in which participants can legally gainshare with physicians for episodes of care, during which the physicians keep costs below a pre-determined target. The goal is to provide hospitals with a mechanism for engaging physicians in cost control efforts. CMS benefits because participating hospitals must offer CMS a discount on services, and hospitals will come out ahead if they leverage the gainsharing to lower costs by more than the discount and/or grow volumes by tightening alignment with physicians. For a more detailed discussion of CMMI's Bundled Payment for Care Improvement Initiative, listen to the recording of our previous webconference and/or download the handout.
Which service lines offer the best opportunity to maximize the return on bundled payments?