Lessons Learned from 90-day Episode Experience for All Specialties

Dr. Tharun Karthikeyan is one of the orthopedic surgeons who improved care and lowered cost in the CMS Bundled Payment Care Improvement (BPCI) Initiative. Dr. Karthikeyan shared these 4 learnings that can be applied across specialties on future quality initiatives.

1. Patients in the focused program experienced better outcomes.

“Our BPCI patients consistently had lower readmission rates, shorter lengths of stay, and lower overall complication rates since institution of the program. These improvements were made while also significantly reducing the Total Medical Spend (TMS) for the entire 90-day episode of care following the hospital procedure.”

2. BPCI patients are more engaged and have higher satisfaction.

“The BPCI program has definitely benefited both my patients and my practice. Because of the care coordination and additional support, patients are far more engaged in their recovery, and have a much clearer idea of what to expect, and why our recommendations and protocols are in place. They also have a greater appreciation for ‘the team’ and understand the roles played by the providers, the office staff, the hospital team and the CIN care managers. In addition to better care and lower length of stays, patients involved in the episode program have higher overall satisfaction rates as well, and are more likely to recommend us to friends or family members who may be considering joint replacement.”

3. Coordination of care and patient education is helpful in all specialties.

“The concept of value-based care is not a new one, and the lessons we have learned from our participation in the BPCI program are absolutely applicable to most, if not all other specialties. Coordination of care before and after the hospital is the key to success for all fee-for-value initiatives. This includes awareness of and involvement in the outpatient, inpatient, and post-acute phases of care. It is important to understand the cost associated with each of these phases, and to identify the areas where patients are most vulnerable to medical complications, unnecessary re-admissions, and duplication of efforts. We can work in conjunction with members of the health care continuum to improve the quality of the care we provide patients, while also working to decrease costs.”

4. CIN Care Management is integral to success.

“The KHP care management team has been integral to our success. They connect with patients before an event, and follow them throughout the recovery process. Because of their specialized focus, they anticipate questions and concerns in a way that our office and hospital staff simply cannot. If there is a complication that does require readmission, they facilitate communication between the patient and provider to make an already stressful situation more streamlined and coordinated. In this way, our patients feel that they have an added resource who is there as a safety net, rather than defaulting unnecessarily to the Emergency Room.”

Dr. Karthikeyan added that patients saw significant benefit when providers took the time to engage, talk with and learn about the patients from the KHP RN health coaches. He continued, “Communication is really the key. Regular meetings and communication regarding acute and complex patients in your patient panel definitely make a difference.”