Those targeted for entry into the program are usually chronically ill patients who have the possibility of dying within a year and have yet not chosen to enter hospice. Once eligible patients have been identified, AIM staff works with them to chart out a plan for the next steps in managing their care. The goal of AIM is to coordinate care for these patients before they reach the terminal stage in order to smooth the transition into hospice.
Eventually the focus of treatment shifts from administering acute procedures to providing more palliative care. AIM staff also helps patients develop advance directives. As patients get sicker, the team helps them move into hospice.
Sutter expanded the pilot after early results showed the rate at which AIM patients entered hospice was 47% compared with 20% among non-AIM patients, according to a 2006 study published in the Journal of Palliative Medicine. A few years later, Sutter began investing $21.4 million into a system-wide rollout of AIM, which was helped along with a $13 million grant in 2012 from the CMS Innovation Center. The AIM model now serves 79% of Sutter's service territory: The program is in 14 out of 19 counties treating an average of 1,200 patients a day.
The program faces challenges, however. The current fee-for-service payment model used by private and public payers does not reimburse for all of the services AIM provides. For example, while the Medicare-certified home healthcare service is reimbursed, any transitional care provided to a patient to enable entering hospice is not reimbursed.
It also sharply reduces revenue by reducing hospital admissions, which has turned AIM into a money-loser for the system. “The rate of the spread of the program will be in direct proportion to the rate that our system converts from fee-for-service toward accountable care,” Stuart said. “The quicker that transition happens, the quicker this (kind of) program will grow.”
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