This past April, nearly 800 hospitals throughout the country became responsible for the post-acute care of Medicare beneficiaries receiving a hip or knee replacement. Three months later a new directive required hospitals to do the same for Medicare beneficiaries with heart attacks, coronary bypasses and hip and femur fractures.
The new orthopedic and cardiac bundled payment programs reflect a new economic reality for hospitals, which traditionally had very little responsibility for post-acute care. In many markets across the country, they now will be responsible for the financial and clinical outcomes of patients for nearly three months after discharge.
It is precisely in these critical post-discharge months that health systems have the least control over patient choice or progress.
There are many reasons for that. Many hospitals lack a dedicated staff member to oversee care once a patient is discharged. The hospitals with staffing often rely on the telephone, which may not work very well on its own, even when combined with more sophisticated telemonitoring techniques such as those that remotely track heart rate, blood pressure and other vital signs.
But failing to monitor and engage patients during the three months after surgery could prove costly. It increases the risk of exceeding the targeted bundled price of care, invoking and paying a penalty.
“Hospitals are being forced to see what happens outside their doors,” said Robert Mechanic, senior fellow and director of the Health Industry Forum at Brandeis University, adding that it can be “eye opening.”