U.S. Health and Human Services secretary, local health care professionals tout proposals to better help patients

July 26--U.S. Health and Human Services Secretary Sylvia M. Burwell, flanked by doctors, health care professionals, insurance providers and patients Tuesday in Jacksonville, touted the planned expansion of federal mandatory bundled-payment models for health care intend to make hospitals nationwide more financially accountable for the cost and quality of care.

Burwell led a roundtable discussion at Brooks Rehabilitation, 3599 University Blvd. South, focusing on the new bundled payment models announced Monday night by the federal Centers for Medicare and Medicaid Services (CMS), which is part of the Department of Health and Human Services.

In a bundled-payment program, the government reimburses health care providers a specific amount per patient for a set of medical services instead of piece-meal for each individual component of the procedure.

Burwell said the focus is on quality, accountability and affordability. It's also abut better coordination of health care via improved communication between providers and the patient, along with increased use of technology and data, she said..

"This is a conversation today about changing the way health works. Better, smarter, healthier is the way we like to think of it in terms of how health care and our health system works in the United States," Burwell said.

The discussion also highlighted Brooks Rehabilitation's successful participation in bundled payments, which is an Affordable Care Act program billed by President Barack Obama's administration as moving the nation's health system towards a structure that rewards the quality of care over the quantity of care, and leading to better outcomes for patients and health care providers.

Burwell said the new bundled-payment models reflect significant policies.

-- New bundled payment models for cardiac care, and an extension of the existing bundled payment model for hip replacements to other hip surgeries.

-- A new model to increase cardiac rehabilitation utilization.

-- A proposed pathway for physicians with significant participation in bundled payment models to qualify for payment incentives under the proposed Quality Payment Program.

The proposed bundled-payment models for cardiac care includes medical as well as surgical services, which will offer new information on how these models affect quality and costs. Along with cardiac rehabilitation proposal and Million Hearts Cardiovascular Disease Risk Reduction program, it is intended to provide a more comprehensive and coordinated approach to patient care in the hospital, a rehabilitation facility and at home.

"With bundling, you get financial accountability and clinical accountability," said Jeff Rich, a cardiothoracic surgeon and physician at Sentara Heart Hospital in Norfolk, Va. Under the program, communication increases between doctors, other health care professions, patients and their care-givers for a more cohesive approach, he said.

Brooks Rehabilitation, based in Jacksonville, is a nonprofit independent health care organization providing medical rehabilitation services more than 40 years. It's 160-bed Jacksonville hospital is one of the nation's largest inpatient rehabilitation hospitals. In addition to inpatient rehabilitation therapy, Brooks offers outpatient therapy at 26 clinics throughout Florida, home health care services and numerous community-based programs

Doug Baer, its chief executive officer, said three years ago Brooks became one of the first hospitals to participate in the bundled-payment program. It uses it for health services to patients recovering from hip fractures, joint replacements, congestive heart failure and spinal injuries, he said.

"As an organization that values innovation, we chose to participate in the bundled-payment for care improvement initiative to be on the forefront of where we felt health care was moving and possible health system reforms," said Baer, adding it's worked out well.

"It's been a transformational program for us here ...It really has allowed us to take a much more holistic view of care across the episode for patients," said Baer, noting its produced better results and outcomes for patients. "We've been able to reduce hospital readmissions, and we've saved costs ...I think its been tremendous for us."

Betty Jane Jenkins said she became a patient at Brooks after fracturing her hip in a fall at home. She and her husband, Steven, who's her caregiver, lauded the bundled-care program citing the nurse navigator who's been working with them throughout her recovery to ensure she has the follow-up health care services she needs.

"I've felt very safe and well cared for," she said.

However, some in the health care industry are cautious.

Tom Nickels, executive vice president for Government Relations and Public Policy at the American Hospital Association, said in a written statement Monday that "America's hospitals already are participating in many programs to redesign care delivery to better serve patients."

Nickels noted the bundled-payment proposal for cardiac care is the third such project from the CMS in a little over a year. The agency is layering that new program on hospitals already working to implement the mandatory hip and knee bundled-payment model, he said.

"CMS also is proposing to expand and further complicate the hip and knee program less than four months after it began and before evaluating its results." Nickels said. "CMS is putting the success of these critical programs at risk. Hospitals are under a tremendous burden to help ensure these complex models work for patients."

Nickels also said "we will fully analyze the proposals and we look forward to improving them so they are reasonable and workable for patients."

Teresa Stepzinski: (904) 359-4075

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