South Florida Hospital News
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February 2017 - Volume 13 - Issue 8

Preparing for Medicare's Big Bundled-Payment Expansion in Cardiac Care

In December, the Department of Health & Human Services (HHS) finalized new models that would shift Medicare payments from quantity to quality by creating strong incentives for healthcare systems to deliver better care at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions and speed recovery.

Three new significant policies will affect cardiac care specifically:
•   New bundled payment models for cardiac care
•   A new model to increase cardiac rehabilitation utilization; and
•   A proposed pathway for physicians with significant participation in bundled payment models to qualify for payment incentives under the proposed Quality Payment Program.
These new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery. It also gives clinicians additional opportunities to qualify for a 5 percent incentive payment through the Advanced Alternative Payment Model (APM) path under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. These models begin their five-year operations on July 1, 2017.
The changes are part of a nationwide shift toward value-based payment systems that aim to reward healthcare providers for quality over quantity of care. This transition from fee-for-service to value-based care continues to be one of the greatest challenges healthcare providers face today.
“The same principles apply to all surgical disciplines - cardiac, orthopedic, neurologic or thoracic surgery, value-based care is about producing better outcomes and reducing costs more efficiently,” says Harold Mondschein, CEO and co-founder of Medtel, a New York City-based company which delivers innovative tools that improve a hospital’s ability to provide best-in-class surgical care at reduced costs.
To survive in this new environment, Mondschein stresses that healthcare institutions will need to continue focusing on ways to increase efficiency, reduce costs and provide better outcomes. Medtel’s clients credit Medtel’s unique ability to identify surgical challenges before they arise as critical to their success in making the mandated transition to value-based care.
“Medtel's user-friendly platform streamlines care, enhances communication, and improves efficiency. We help providers prepare differently for each individual’s episode of care,” explains Mondschein. “MedTel provides the entire surgical team with an opportunity to understand the risks for each procedure so they are adequately prepared to deliver a successful outcome.”
The bundled payment models which are defined as a single payment for all care provided to a patient during a defined episode of care, are designed towards hospitals and surgeons for improving both the clinical outcomes and lowering costs under value based care. The potential impact on hospitals is enormous. In fact, Medicare estimates that they will reduce their costs by over $170 million in five years by rewarding hospitals that take the steps necessary to produce better outcomes and penalizing those who do not.
To help providers improve their ability to provide best-in-class surgical cardiac care and to meet these new mandates, Medtel introduced the Medtel AIM (Assigned Intervention Measure) last fall. This tool is a predictive model that helps providers reduce readmissions by identifying amenable risk factors for each patient, so that care givers can optimize each patient prior to surgery.
“We want to ensure that all members of the surgical team are on the same page at the same time,” says Mondschein. “The entire team knows which patients are at risk, identifies the risk factors, and suggests interventions to optimize each patient. In doing so, you become more efficient, reduce your costs and improve your outcomes.”

For more information or to schedule a demo, visit

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