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PFM Partner Spotlight: Partnership for Quality Home Healthcare

Partnership for Quality Home Healthcare

Partner Spotlights reflect the views of PFM’s partners, not necessarily of PFM.

In 2011, there were nearly 11.5 million hospital discharges completed for Medicare beneficiaries who, in total, received more than 65.8 million days of hospital care, according to the Centers for Medicare & Medicaid Services.  Following treatment in the hospital setting, a growing number of these patients are requiring post-hospital – or post-acute – services, which are needed medical services for acute, chronic or rehabilitative conditions that can also reduce additional hospitalizations.

Increasingly, both lawmakers and healthcare providers are advancing policy and procedural reforms to reduce hospital readmission rates by improving care coordination, reducing inefficiencies in the current system, reducing costs and – most importantly – achieving optimal patient outcomes. Policymakers know that providers often work in silos, not providing the most optimal care continuum for the patient.  Under existing policies, incentives can lead to patients being moved from one post-acute care setting to another with little consideration for the most appropriate setting for further medical care.  Simply put, there is often no rational determination for why or how a patient receives healthcare following a hospitalization, and many times patients return back to the hospital, doubling the costs of care.

To address this need, lawmakers in Congress have introduced the Bundling and Coordinating Post-Acute Care of 2014 (BACPAC Act).  The BACPAC Act aims to identify and coordinate the delivery of post-acute care in the most cost-effective and clinically-appropriate setting after a patient is discharged from the hospital.

The BACPAC model works by allowing post-acute care coordinators and their networks of providers to manage care for a patient in a 90-day, site-neutral bundled payment that begins when the patient is discharged from the hospital. Participants are rewarded when the total cost of care is lower than the bundle amount and the patient does not return to the hospital. This, in turn, creates a powerful incentive to seek the best quality providers, ensuring the right care, in the right setting and at the right time.

Most importantly, the BACPAC Act paves the way for patient choice when it comes to receiving post-acute care. The legislation allows patients, their families and physicians to be fully informed on the variety of care options after hospital discharge. Patients are able to choose their post-acute coordinator and therefore their providers, ensuring the patient is able to receive care in the setting he or she prefers.

And costs cannot be overlooked.  They are central to the Medicare debates taking place in Washington. Data show the BACPAC approach has the potential to save Medicare as much as $100 billion over ten years.

BACPAC offers policymakers the innovative approaches to care delivery and new models for payment necessary to protect the Medicare program and its beneficiaries to ensure America is able to keep its promise in caring for our nation’s most vulnerable, sick and elderly citizens well into the future.

Thursday, June 19, 2014