Atlantic Health System Hospitals Develop Best Practices to Improve Care Coordination, Reduce Cost
MORRISTOWN, NJ - Atlantic Health System’s Morristown Medical Center received the second highest reimbursement in the country for its year one performance in the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) model. The reimbursement is based on quality and safety, and is a testament to Atlantic Health System’s new care coordination model for patients undergoing knee and hip replacements.
Under a program launched by CMS in 2016, hospitals performing hip and knee replacement surgeries were financially rewarded based on how well their patients did—for example, hospitals were reimbursed at a higher rate when patients were not readmitted to the hospital for complications related to their surgery, had the support they needed to recover well, and were able to return home quickly. Traditionally, hospitals have been paid based on how many surgeries were performed.
“Our team at Atlantic Health System completely redesigned the way we care for our patients undergoing hip and knee replacements, from the time the patient and doctor make the decision to proceed with surgery through recovery,” said Steven Maser, MD, Medical Director, Orthopedic Surgery, Atlantic Health System. “By taking a critical look at what a patient needed and working in tandem with the patient’s family and all of the medical professionals involved in care—nurses, surgeons, patient care navigators, skilled nursing facilities/rehabs, and at-home nursing care—we were able to develop a new model that streamlines care to ensure quality, and is more efficient. We are incredibly proud of this.”
Four Atlantic Health System’s hospitals—Morristown Medical Center (which has the seventh highest CMS volume in the country for joint replacement surgeries), Overlook Medical Center, Chilton Medical Center, and Newton Medical Center—participated in the program.
The largest shift in the standardization of care was sending appropriate patients home to recover, versus the standard practice of sending them to rehabilitation or a skilled nursing facility. Under Atlantic Health System’s new model, there was a 117 percent increase in patients discharged home.
Initial data showed that the use of skilled nursing facilities post-procedure was extremely high, so Atlantic Health System worked to employ a risk assessment model to ensure those patients who could go home were able to do so with proper post-operative support and resources.
:"We know that patients who recovered at home were happier in the comfort of their environment, moved more because they were familiar with the space, had less exposure to germs from other patients, and would simply save money by not unnecessarily going to a skilled nursing facility,” Maser said.
Atlantic Health System’s data of patients who had their hips and knees replaced in 2012, 2013, 2014, and between April 1 and September 30, 2016 showed that patients with the same number of chronic conditions were more than twice as likely to return to the hospital within 90 days after surgery if they were admitted to a rehabilitation or skilled nursing facility rather than being discharged to home.
Overall, this change in process yielded an average decrease of 6.7 hospital/skilled nursing facility days and nearly $4,000 cost savings per patient episode.
Additional best practices under Atlantic Health System’s streamlined care coordination model include:
- One system-wide standard of care for all CJR patients--order sets, care guidelines, and patient education—implemented across all four hospitals by a steering committee
- Strengthening relationships with in-home health services, and building relationships with new ones in areas where patients were underserved
* Surgeon education (hospital-employed and independent physicians with privileges to practice at an Atlantic Health System hospital) on new care standards, and transparent sharing of reimbursement data on a case-by-case basis so surgeons could understand how they were measured compared to their peers
* Addition of “Navigators”—nurses who communicate with the patients before, during, and throughout the 90-days after their procedures, to ensure all clinical resource needs (at-home care, medication questions) are answered quickly. For patients who did end up going to a skilled nursing facility, the navigators were also instrumental in communicating with the skilled nursing facilities to ensure the patient was receiving the suitable care and length of stay was appropriate.
Atlantic Health System’s CJR team—Steven Maser, MD, Medical Director of Orthopedic Surgery, Jim Smith, Administrative Lead on CJR, Mina Le Fevre, System Central Navigator for CJR, and Lauren Johnson, project manager—presented these best practices at a CMS Webinar to other hospitals nationwide. Additionally, Jim Smith and Lauren Johnson presented at national conferences, including the 2017 HFMA ANI and the 2017 Change Healthcare Inspire conference, on the use of data and technology in a successful bundle care model.