Date Presented 04/04/19
This study examined the bundling payment methodologies in regard to patient quality of care for individuals receiving hip and knee arthroplasties. Perspectives of healthcare professionals and administrators across the continuum of care were gathered to identify common themes.
Primary Author and Speaker: Katherine Lally
Additional Authors and Speakers: Vanessa Jewell, Helene Lohman, Melinda Schultze, Hannah Ehresman
Contributing Authors: Lynette Akai, Kelsey Russell
PURPOSE: In 2016, the Centers for Medicare and Medicaid Services mandated the participation of hundreds of hospitals in the Comprehensive Care for Joint Replacement (CJR) bundling initiative. The bundling initiative required care across the continuum of inpatient and post-acute settings that is delivered within a certain amount of days to be included into one bundled payment (Navathe et al., 2018). The aging population combined with the increasing prevalence of obesity will cause hip and knee replacements to be at an even higher demand in future years (Mallinson et al., 2011). Therefore, it is crucial to examine the coordination of care of all healthcare providers across the continuum (preoperative care, acute, post-acute). The purpose of this study was to explore the perceptions of health care rehabilitation professionals and administrative personnel on the coordination of care for patients who received hip or knee arthroplasties under the bundling initiative.
DESIGN: Researchers used a broad qualitative approach and convenience sampling to recruit two groups of participants; a group of rehabilitation healthcare professionals consisting of three nurses, two occupational therapists, and three physical therapists, and a second group of hospital and post-acute care administrators of two physical therapists, an occupational therapy assistant, a nurse, and a licensed administrator. All participants worked in either acute or post-acute care and had experience with the bundling payment model.
METHOD: Researchers collected data through a focus group, email communication, and individual phone interviews. After transcription of all interviews, the six phases of thematic analysis were used to identify, analyze, and report patterns within the transcribed data to form themes. Trustworthiness was established by member checking, reflexivity, keeping an audit trail, researcher triangulation, use of a thick description, and peer debriefing.
RESULTS: Four final major themes were identified: the importance of care coordination, increased efficiency and effectiveness, establishing protocols, and challenges of bundling. A major theme among participants was the perspective that the bundling initiative led to the establishment of effective protocols that are then applied to all patients regardless of payment method to decrease the length of stay post operation. The importance of establishing a contact person for patient assistance and post-operative follow up was perceived as being a crucial factor in the success of improving coordination of care under the bundling initiative.
CONCLUSION: This study provided rehabilitation healthcare professionals and administrative personnel in a bundling initiative with an opportunity to express their opinions about the initiative and its impact on coordination of care. Perceptions demonstrated that the bundling initiative can be effective in managing and coordinating the care of patients when interprofessional communication exists among providers.
IMPACT STATEMENT: With limited research on the implications of the bundling initiative within a hospital setting, these findings have an important insight on the perceived benefits of collaboration to reduce readmissions and maximize patient outcomes. The findings indicate significance of interprofessional collaboration and communication, the establishment of patient autonomy, and adherence to rehabilitation protocols among all healthcare providers to lead to increased coordination of care for patients across the continuum.
References
Navathe, A. S., Liao, J. M., Shah, Y., Lyon, Z., Chatterjee, P., Polsky, D., & Emanuel, E. J. (2018). Characteristics of Hospitals Earning Savings in the First Year of Mandatory Bundled Payment for Hip and Knee Surgery. JAMA, 319(9), 930-932.
Ramos, N.L., Wang, E. L., Karia, R.J., Hutzler, L.H., Lajam, C.M., & Bosco, J.A. (2014, September). Correlation between physician specific discharge costs, LOS, and 30-day readmission rates: An analysis of 1,831 cases. The Journal of Arthroplasty, 29(9), 1717-1722. https://doi:10.1016/j.arth.2014.04.005
Parcells, B. W., Giacobbe, D., Macknet, D., Smith, A., Schottenfeld, M., Harwood, D. A., & Kayiaros, S. (2016). Total joint arthroplasty in a stand-alone ambulatory surgical center: Short-term outcomes. Orthopedics, 39(4), 223-228. doi:10.3928/01477447-20160419-06
