A readmission can more than double the episode cost.
Chart 6: Cost of 30-day Fixed-length Episode with and without a Readmission, 2007-2009 $32,262 $29,803 $23,527
No Readmission Readmission
$23,034
$18,128
$12,301
MS-DRG 247
$19,243
$14,977
MS-DRG 470
MS-DRG 481
$23,844
$12,075
$5,514
$8,492
MS-DRG 192
MS-DRG 194 MS-DRG 291
247: Percutaneous cardiovescular procedure with drug-eluting stent w/MCC 470: Major joint replacement or reattachment of lower extremity w/o MCC 481: Hip & femur procedures except major joint w/CC 192: Chronic obstructive pulmonary disease w/o CC/MCC 194: Simple pneumonia & pleurisy w/CC 291: Heart failure & shock w/MCC Source: Dobson | DaVanzo (2012). Medicare Payment Bunding: Insight from Claims Data and Policy Implications.
PEAK RESOURCES BUNDLE PAYMENT INITIATIVE 101 Baines Court, Cary, NC 27511 Telephone: (919) 290-2722 Fax: (919) 447-7945
www.peakresourcesinc.com
To reduce the cost of care throughout the post-acute continuum for Medicare and Medicaid beneficiaries.
ON A QUARTERLY BASIS WE CAN ELECT TO ENROLL IN MORE EPISODES AS DEEMED NECESSARY
highest rate of Episodes readmission
ACUTE MYOCARDIAL INFARCTION
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
CONGESTIVE HEART FAILURE
Who We Are HOW ARE WE GOING TO ACCOMPLISH?
1. Most significant area of opportunity is to reduce the number of hospital readmissions. Not only within the first 30 days but throughout the entire 90 day episode
HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT
SIMPLE PNEUMONIA AND RESPIRATORY INFECTIONS
a. Early intervention of Home Health b. Medipak@Home where we provide 30 days of medications upon discharge. c. Advanced Directives discussed upon admission d. Disease specific care paths e. Use of INTERACT root cause analysis for all unplanned hospital discharges f. Use of INTERACT stop and watch too! g. Setting up primary care physician visits prior to discharge
2. Collaboration is necessary with Medical Directors, Home Health, Primary Hospitals and Primary Care physicians.
4. Care Transition Navigator will be in place to monitor bundled payment beneficiaries as well as internal and external process improvement efforts.
3. Identify changes needed in our internal processes to improve the transition of care
5. Developing Gain-Sharing protocol to incentivize each party throughout the continuum of care.
April 1, 2015 Awardee Facilities Peak Resources Charlotte Peak Resources Cherryville Peak Resources Gastonia Peak Resources Treyburn
July 1, 2015 Awardee Facilities Peak Resources Alamance Peak Resources Pinelake Peak Resources Shelby