Bundled Payments in the Spotlight, Stent Retriever Window Widens and More

Bundled payments have been big in the news in the past couple of weeks — for better, worse or otherwise. They figure prominently in this sample of items of note to the cardiovascular care community that drew the attention of Cleveland Clinic Miller Family Heart & Vascular Institute Chairman Lars Svensson, MD, PhD.

Lars Svensson, MD, PhD

Unbundling divergent views of bundled payments — Bundled payments have been adopted by 31 percent of U.S. hospitals and 20 percent of U.S. employers, but the two groups look to care bundles for very different things. So suggests the latest annual survey on bundled payments by PricewaterhouseCoopers, as reported by Modern Healthcare and Becker’s Hospital Review. While employers want to see greater financial impact and a wide variety of bundles, especially for chronic conditions, hospitals have tended to offer bundles almost exclusively for a few acute conditions that are easier to define and manage. Meanwhile, although 7 in 10 consumers had never heard of bundled payments, 8 in 10 of them liked the concept once it was explained.

Early reviews are in on CMS’ bundled payment plan for cardiac treatment — And they’re not glowing, reports Healthcare Finance News. Two months after CMS requested comments on the plan, input from major healthcare organizations is mounting. The Healthcare Information and Management Systems Society suggests changes to enhance transparency and make use of new technologies in services related to episode payment models. The Federation of American Hospitals warns against “a rush into new bundled payment models” before results from those now being tried (such as for joint replacement) are fully examined. And the AMA criticizes CMS for failing to take comments from specialists before issuing the proposed plan. Meanwhile, a letter from House Budget Committee Chair Tom Price, MD, and 178 other members of Congress has called on CMS to halt its proposed mandatory bundled payment programs, including those for CABG and acute MI.

‘Golden window’ for stent retrievers may extend to 7 hours — The time window for intervention with endovascular thrombectomy in acute ischemic stroke appears to be a bit longer than we thought. Current guidelines recommend that endovascular thrombectomy be performed (in addition to medical therapy) within six hours of stroke onset. While a new meta-analysis in JAMA confirms that every hour counts — each one-hour delay to reperfusion was associated with greater disability at three months — it also finds that patients treated with a stent retriever as late as 7 hours 18 minutes after stroke onset still had significantly better three-month disability outcomes than patients receiving medical therapy alone.

Hospital choice for MI pays off long-term — Being admitted to a high-performing versus a low-performing hospital after acute MI yielded survival benefits from the first 30 days all the way through 17 years of follow-up. So finds the Cooperative Cardiovascular Project study of 120,000 Medicare patients with acute MI admitted to 1,800 hospitals between 1994 and 1996, as reported in the New England Journal of Medicine. Average life expectancy 17 years later was nine to 14 months longer for those treated at hospitals that perform best on widely used quality measures than for those treated at low-rated hospitals, after accounting for case-mix severity. “Where you go really does matter,” one of the study leaders told the Associated Press.

So long, good times? — Median operating profitability for nonprofit hospitals and health systems rose across all categories in fiscal year 2015, says a new report from consulting firm Fitch Healthcare, as reported by Becker’s Hospital Review. But Fitch expects operating performance and profitability to be “more volatile” in FY 2016 and beyond, citing reasons that include growth in Medicare beneficiaries, further CMS implementation of value-based reimbursement models (such as bundled payments), increasing healthcare utilization by Medicaid patients, and labor and wage pressures for clinical staff. “The likelihood of margin compression will be greater for hospitals with less experience in managing risk and those with smaller revenues bases and mostly fixed expenses,” the report notes.