'A Coalition of the Willing'
Many of the hospitals that participated in the BPCI already had much of the clinical and data infrastructure they needed to pull off the shift, said Kevin Bozic, MD, a surgeon at the University of Texas at Austin. He studies value-based care and orthopedics. Bozic, who is also chair of the school's surgery and perioperative care department, calls those hospitals "a coalition of the willing."
"We figured out we can do this in the places that were prepared," he said. "But what about the places that are not prepared? How are we going to bring them along, because they will just stay in the fee-for- service world forever unless they have some incentive to move."
"Move" might be an understatement. Everyone I talked to about bundled payments offered a long list of clinical and data programs that need to be in place to make this work. Bozic said it took two years to set up the program at UT.
It's not that hospitals don't have their acts together, Franklin said.
"It is a new paradigm," she said. "Your hospital could have a great financial system for monitoring your in-house costs and utilization, but when you are trying to understand the 30- 90-day period, you probably didn't collect the total cost of the nursing home or ER visits. It is very much a new information infrastructure."
That's something her group is willing to help out with. FORCE-TJR has tracked more than 25,000 patients and their surgeons who are already using an episode management system that includes data on patient reported outcomes (PRO)—one of three measures CMS will use to assess quality. The group offers to use its benchmarks to help hospitals assess their readiness for the new program.
They have lots of competition. The changes brought about by the ACA have birthed an army of consultants willing to help hospitals figure out how to collect and crunch data. Those who offer help on the CJR bundles staffed booths at the American Association of Orthopedic Surgeons meeting. They advertise in publications like this one and have taken to social media to tout their services, which come in the form of remote monitoring, podcasts, software and webinars.
Tinker Ready is a contributing writer at HealthLeaders Media.