Hospitals will definitely need help on the analytics side, says Bozic. The shift, however, will require much more effort.
"Most of what it is going to take to be successful in bundled payments you are not going to get from a consultant," he said. "It's trust and alignment from the clinical community and you can't buy that from a consultant. You need strong physician leaders who can lead change."
Franklin agrees that hospitals need to ensure that the clinical pieces are in place. In the survey, 75% of respondents said they were hiring staff. That makes sense, she says, because they'll need clinical nurse managers, transition coaches, or navigators who will track the patient through the entire 90-day episode of care.
Data is Key
The other piece is the data analysis, she says. Some integrated health system will have the data infrastructure needed to track patients, collect data, and improve care.
Some may not, so they had better move on it. Data is key to this and any quality improvement effort.
Thomas Barber, MD, is an orthopedic surgeon at the Kaiser Oakland Medical Center and a spokesman for the AAOS on bundled care for joint replacement. He the agrees that clinical, data and infrastructure needs must be met before the hospitals can successfully handle the CJR program. He thinks a lot of hospitals have pieces, but haven't yet put them together yet. They will, but probably not by April 1. But since the program will be phased in, that won't be a problem for a while, he says.
"It is going to be a challenge to put all those pieces together and manage it well," he says. "If you think 50% of the hospitals are well prepared for CJR, I would be skeptical. "
Dare we say that bundled payments will allow, or force, hospitals to tackle a lot of their problems at once? What about the need for good data systems, lower costs, and better quality? Tackle may be the appropriate term. The consensus seems to be that this is a huge complicated job, but it has to has to happen, and it and will.
"It is a significant amount of work for a large amount of people," Bozic said. "They night not know where to start. There is really no good blueprint for this."
Tinker Ready is a contributing writer at HealthLeaders Media.