The Tide of Change is Coming for Reimbursments

December 4, 2015
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I have been in healthcare my entire career and have seen lots of change in some form or fashion for this industry. But, as many will attest to, BIG change is fast approaching when it comes to reimbursement. That was very evident at a recent conference I attended – The American Association of Hip and Knee Surgeons – AAHKS. Change in reimbursement was the common theme and the ones shouting it from the roof tops were the industry expects, the surgeons in the trenches, and us – the vendors.

I have been in healthcare my entire career and have seen lots of change in some form or fashion for this industry. But, as many will attest to, BIG change is fast approaching when it comes to reimbursement. That was very evident at a recent conference I attended – The American Association of Hip and Knee Surgeons – AAHKS. Change in reimbursement was the common theme and the ones shouting it from the roof tops were the industry expects, the surgeons in the trenches, and us – the vendors. Although many are getting ready for this tidal wave, there are still the ones, very few, that are digging their heels in hoping to ride out the wave. I think they’ll likely crash head first.

In January 2016, bundled payments will be here for total joints via the Comprehensive Care for Total Joints mandates from CMS.  The sessions I attended at AAHKS made it loud and clear: surgeons need to be prepared for this change. What they need to be prepared for could be anywhere from working collaboratively with their hospitals partners to really understanding the data for process improvement, results and patient engagement. All of these efforts are needed to drive value for their practices, partners and ultimately the patient. No longer are the days where practices, departments or hospitals can stand alone in this journey.

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Dr. Thomas Vail from UCSF suggested in order to attract patients that still have a choice, physician practices and health systems must work together to drive value and make that the centerpiece to improve outcomes. Furthermore, instilling competition among the care teams will instinctively drive better behavior and thus, have shown to improve patient satisfaction stats in those departments.

Every department at UCSF will be effected by change in reimbursement. They use the data to drive a strategy of quality, safety, efficiency and financial performance to help mitigate the risk fact that goes along with this change in reimbursement. The data will show trends to drive change verses just looking at individual metrics. Their focus is on the goals that focus on the measurements.

During a panel discussion on Patient Reported Outcomes – This is Your Reality, it was all about engaging the patient. Dr. Kevin J. Bozic from Dell Medical School at UT Austin, PROs are the “holy grail” for measuring quality. Physicians should understand patient outcomes are based on the patient’s expectations and the cost it takes to get to that outcome.

Orthopedic society groups such as AAHKS, AAOS and AJRR are taking it upon themselves to bring the PROs up to today’s reality by working together to modify the surveys to make them more patient friendly – thus getting the patient more engaged. (These recommendations are awaiting CMS approval.) Also, there is a big push to ensure there is a “risk adjustment” factor taken into consideration in order to make it a level playing field given the diversity of total joint surgery and the different levels of complexity. However, regardless of any update or approval by CMS, the panel agreed that obtaining RPOs will be the cost of doing business. Last, which I believe supports the need for patient engagement technologies, Dr. Bozic closed with……“It (PRO) will be a nice to have to a need to have”.

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The Tide of Change provides a tremendous opportunity to all of us who look to make a difference in the way technology can improve the delivery of healthcare but most importantly, provide the patient with a better experience.