“Using our extensive benchmarking database, CCGroup identifies a Midwest health system client as being in the upper performance tier for treating lower extremity joint replacements (LEJR) under the CMS Transforming Episode Accountability Model (TEAM),” stated Dr. Douglas G. Cave, President/CEO of CCGroup.
He continued, “Our health system client participated in the CMS Bundled Payments for Care Improvement (BPCI) initiative for knee/hip replacement. During this time, the health system implemented a new operating model where knee/hip replacement surgery moved from inpatient facility to outpatient facility and ambulatory surgery center (ASC) settings. Now, our client is mandated to participate in CMS TEAM bundles payment.”
CCGroup determines LEJR TEAM bundle results using the CCGroup-CMS Innovator Project. “The CCGroup-CMS Innovator Project is a Cloud/SaaS Subscription Model offering that has efficiency and quality results for most practicing specialists in the United States,” explained Dr. Cave.
“The CCGroup-CMS Region LEJR bundle average is $20,500, while our client’s average is $17,000 (or 17% more efficient),” stated Yuri Alexandrian, COO of CCGroup. A main reason for bundle efficiency improvement is the significant movement from inpatient to outpatient facility for our client’s LEJR bundles. For instance, the CCGroup-CMS Region average is 55 admissions per 100 LEJR bundles as compared to our client’s average of 23 admissions per 100 LEJR bundles. “This finding decreases our client’s average inpatient cost to $3,300 per bundle as compared to the peer group’s average of $8,300 per bundle (or 60% less),” explained Mr. Alexandrian.
Dr. Cave mentioned, “Inpatient facility reduction is only half the battle to achieving a high performance bundle rating. A health system also needs to reduce adverse events as measured by unplanned hospital readmissions and the CMS patient safety and adverse events (PSAE) composite. Our client’s PSAE composite is 30% of all LEJR bundles, while the CCGroup-CMS Region PSAE composite is 19% (both are higher than expected). The key adverse event category is complications directly related to surgery. Our client understands the need to address ASC quality improvement.”
Moreover, during the 30-day follow-up period, health systems must address the appropriate post-acute care level of rehabilitation facility and home health care (Rehab/HHC) services. Mr. Alexandrian defined, “In many instances, we observe savings achieved from lower LEJR inpatient facility utilization that is mostly offset by overutilization of Rehab/HHC services. However, this is not the case for our client where the average Rehab/HHC amount is $775 per bundle as compared to the peer group of $1,200 per bundle (or 35% less).” CCGroup benchmark results show average Rehab/HHC per LEJR bundle varies from $450 to $3,100 – over a 6-fold difference.
Future press releases will address CCGroup client-related results for CMS TEAM surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.
About Cave Consulting Group, Inc. (CCGroup)
Cave Consulting Group, Inc. is a software and consulting firm located in San Mateo, California. The company is focused on improving the efficiency (cost-of-care) and effectiveness (quality-of-care) of the healthcare delivery system. Senior management of CCGroup has assessed the performance of physicians and hospitals for over 33 years for health systems, provider groups, CINs, ACOs, health plans, HMOs, and TPAs.
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“The CCGroup-CMS Region LEJR bundle average is $20,500, while our client’s average is $17,000 (or 17% more efficient),” stated Yuri Alexandrian, COO of CCGroup.
Contacts
Mr. Yuri Alexandrian, CCGroup
650-286-4100
yalexandrian@cavegroup.com
