'Bring it on': Why one hospital says it's fired up for mandatory bundles

'The first clinical challenge is engaging your physicians'

Meriter Hospital launched its first bundled payment program in 2012—and the 448-bed facility originally had "no roadmap" for success, Philip Swain, the provider's director of orthopedics and rehabilitation, tells HealthLeaders Media.

Three years later, Meriter officials have expanded their participation in bundled payment programs, seen impressive results, and feel prepared for Medicare's plan to mandate bundled payments through the Comprehensive Care for Joint Replacement (CCJR) model.

There is "very little we have to do to prepare for" CMS's proposed mandatory bundles, Swain tells HealthLeaders Media.

Here's how Swain says the hospital went from having no roadmap to saying "Bring it on!" to CCJR.

Details of program

Meriter's initial bundled payment program began with a focus on knee replacements, and in 2014 it expanded into using bundled payment for hip replacements as part of CMS's Bundled Payments for Care Improvement program.

Swain says taking on bundled payments required Meriter to rethink its claims processing and to evaluate how Medicare gainsharing— financial arrangements with other providers involved in the episode of care—would work.

Meriter expected to cut costs with bundled payments—but its results exceeded expectations, Swain says. "What I didn't expect is people are getting better care and better outcomes," he adds.

Since 2013, officials say the hospital's joint replacement bundled payment programs have led to a 68% decrease in hospital readmissions, a 23% decrease in patient discharges to skilled nursing facilities (SNFs), and a 12% decrease in length of stay.

To get customized data on your 90-day joint replacement episodes, hospital members can click hereNote: If you don’t see your hospital’s data in the tool, please request access by emailing analytics@advisory.com.

Keys to success

Physician engagement. "The first clinical challenge" with bundled payments, Swain says, "is engaging your physicians." Meriter gathered all of its employed and non-employed orthopedic surgeons together to make sure everyone was on board. "If you can't get physician buy-in for bundled payments, you have a tough hill to climb in achieving success," Swain says.

Want to engage your physicians in compensation redesign? Here's step one.

Care coordination. Meriter is using online patient engagement tools, and also has dedicated members of the nursing staff assigned to work with patients from the time of their admission to several weeks after they are discharged. "The care navigators hold the hand of the patient all the way through the episode of care," Swain explains.

Meriter has also hired a project manager, who coordinates the efforts of doctors and the hospital's financial team, and also works as a liaison with CMS. The hospital has also assigned an internal financial analyst to monitor data on the bundled payments initiative.

Developing post-acute care knowledge. The hospital "had a poor understanding of the post-acute world" before it started its bundled programs, Swain explains—but worked hard to the change that, especially for the SNF and outpatient rehabilitation landscape.

Swain says that Meriter officials met with SNFs to make sure they shared the same priorities of minimizing utilization while achieving the best outcomes, and found that some were on the same page, while others were not.

In addition, the hospital analyzed Medicare data on SNF's readmission rates, costs, claims, and length of stay to encourage patients to go to the highest-performing facilities.

Swain expects that "in the next year or two, hospitals are going to be developing essentially narrow networks for post-acute-care" (Cheney, HealthLeaders Media, 9/21).

Understand the integrated care advantage

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