Presentation Vu Medi SDS 1
2014-12-02
: Pdf Vumedisds 1 VuMediSDS_1 12 2014 pdf
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12/1/2014 Same Day Total Joint Arthroplasty Surgery Overview History of Advanced Center for Surgery in Altoona, PA Establishing a Same Day Joint protocol − − − Getting Started Aligning Goals across care teams Preparing and Implementing protocols Care Pathway Assessments − − Anesthesiologist Home Health Services Surgery featuring VISIONAIRE and JOURNEY II BCS − − − Patient arrival Intraoperative care Patient discharge Patient Testimonial Panel of experts − − − CRNA: Dave Berkheimer Home Health Care Services: Amy Hancock and Sheena Henry Reimbursement expert, CEO UOC and Director of the ACS: Dave Davies WWW.SAMEDAYJOINTS.COM ©2013 Same Day Joints, All rights reserved. Disclosures Dr. Kenneth Cherry - Consultant, Smith & Nephew Dr. Christopher McClellan -Consultant, Smith & Nephew -Consultant, Corentec Inc. -Consultant, Pacira Pharmaceuticals Dave Davies, CRNA -Consultant, Bbraun Medical -Consultant, Kimberly Clark Pain Management 1 12/1/2014 Advanced Center for Surgery First TKA performed December 2012 − − 126 TJA performed with measured outcomes 55 THA and 71 TKA FREESTANDING SURGICAL CENTER − − − 0.125 Stay – NOT 23hr program Home in 3-4 hours from surgery Highly advanced protocols Patient Demographics − − − − − Age 22-72 BMI less than 50 68 Female and 58 Male ASA Classification 1 and 2 only 1st Revision Discharge − − − No OTHER option, all d/c straight home Requires excellent communication between all providers Care Pathway management This is “accountable care” at its highest level WWW.SAMEDAYJOINTS.COM ©2013 Same Day Joints, All rights reserved. Where to start? Understand your Practice and Patient Demographics – Referral Base Assess team’s clinical capabilities – – – Surgical Anesthesia PT Evaluate service line resources – – – PT Home Nursing Home Pharmacy Negotiate payer contracts in advance Understand costs and necessary resources – – – Facilities Instruments Staffing Implement a Joint Coordinator Identify Team Leaders WWW.SAMEDAYJOINTS.COM ©2013 Same Day Joints, All rights reserved. Communication Communication begins with the first office visit – Patient Education Cloud Based Care Pathway – – Multi-disciplinary contact Direct and Rapid Electronic Communication Open communication amongst all providers – Vital to ensure safe and successful joint program Care is protocol driven – – Changes in patient status, care or condition is communicated to all providers Protocol changes are implemented at Joint Team Board level and communicated WWW.SAMEDAYJOINTS.COM ©2013 Same Day Joints, All rights reserved. 2 12/1/2014 Preparation Educate referral base of new improved patient options Educate office staff and care teams – – – – Care Pathway and Implementation Home Nursing Physical Therapy Home Pharmacy Educate surgical team – – – Anesthesia Protocol Procedure Care Pathway Implementation Train, Practice, Discuss! – – – Surgical Run Through Equipment/Supplies Pharmaceuticals Data collection – PI with Care Pathway Process in place WWW.SAMEDAYJOINTS.COM ©2013 Same Day Joints, All rights reserved. Implementation Office Visit – – – Patient Complaint- Pain/Arthritis/Avascular Necrosis Alternatives to Total Joint Replacement have not aided patient complaints Severity of Disease-Requires Surgical Intervention Patient – – – Surgical Candidate Motivated Wants to avoid inpatient stay Same Day Joint Replacement Candidate – Meets selection Criteria Patient Education – – Identify and understand Home Care Needs Patient Responsibilities Initiate Care Pathway through Joint Coordinator WWW.SAMEDAYJOINTS.COM ©2013 Same Day Joints, All rights reserved. Patient Arrival 3 12/1/2014 Anesthesia and It’s role in Accelerated Recovery Healing at Home Reimbursement – Same Day TJR Payer Limitations • Medicare Exclusions “Inpatient Only” procedure; ASC Covered procedures • Commercial payers dependent on Medicare coverage policies Licensing Restrictions • Approved procedure exclusions of Total Joint Codes Participating Payers • Highmark Blue Cross/Blue Shield ACS Facility Reimbursement • Negotiated Fee for Service (Procedure Based) plus Cost carve outs for Implants Physician Reimbursement • Incentive Based Fee for Service (Procedure based payment increases based on Episode Quality and Cost Performance) Under Development • Retail Bundled Pricing 4 12/1/2014 Cost Per Episode • ASC v. Hospital – Clinical advancements and cost efficient protocols are generally portable and can be applied in a hospital based setting. – Hospitals conceptually recognize the need to adapt and share with consumers lower unit costs – Convincing Hospitals to pass cost savings to the consumer in terms of lower pricing or out of pocket expenses remains a challenge Partnering with Payers “It’s like bringing Moneyball to health care”- Brett Morris, President of Health Net of Arizona •Health Insurers recognize that narrow networks improve cost and quality performance predictability •Desirable networks include physicians who practice evidence based medicine AND utilize cost effective facilities •The gateway to earning payment incentives for physicians is quality, and the means for insurance companies to fund the incentives is lower facility cost. •Physicians practicing quality medicine in high cost venues will end up in those network tiers that will require the patient to pay an increased cost to access them •Today, low costs and high value trump provider choice VISIONAIRE & JOURNEY II Overview 5 12/1/2014 Surgery & Patient Post-Op Contact Information 6
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