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Telehealth Helps CMS Bundled Payment Program Show Some Savings

A study in the New England Journal of Medicine finds that CMS' bundled payment program for joint replacements can save providers some money if they use a telehealth platform instead of discharging patients to an acute-care facility.

Source: ThinkStock

By Eric Wicklund

- Mandatory bundled payment programs for joint replacement surgery can save a modest amount of money through the use of telehealth services for rehab, according to a recent analysis.

As reported in the New England Journal of Medicine, an analysis of the first two years of the Centers for Medicare & Medicaid Services’ Medicare implemented Comprehensive Care for Joint Replacement (CJR) program for hip and knee replacements saw a savings of roughly 3 percent per procedure. That savings was attributed primarily to an almost 6 percent decrease in patients sent to care facilities.

“(I)t appears that hospitals may have successfully identified patients who are at the margin of needing post-acute care services who could instead be safely discharged home with home health services,” the study reported.

The study, led by Michael L. Barnett, MD, of the Department of Health Policy and Management at Harvard T. H. Chan School of Public Health, and colleagues from Harvard Medical School, Brigham and Women’s Hospital and the Washington University School of Medicine in St. Louis, points to the effectiveness of a physical rehabilitation program delivered via telehealth to the patient’s home.

Providers are finding that a connected health platform gives them the flexibility to schedule rehab sessions at the patient’s convenience, allowing the patient to recover at home while being monitored by a care team. Such programs reduce travel costs, improve patient engagement and outcomes and enable providers to use remote patient monitoring technology to keep track of more patients.

While this report focus on CMS’ bundled payment program, it’s not the first time a study has found benefits in a connected care platform for rehab over post-acute care services.

Just last year, researchers at Duke University found that providers saved roughly $2,750 per patient by using telehealth instead of in-person treatment for post-discharge physical therapy after knee replacement surgery.

“Physical therapy is a critical component of recovery for patients following total joint replacement surgery,” Janet Prvu Bettger, PhD, an associate professor with the Duke Department of Orthopedic Surgery and principal investigator of the study, said in a press release. “As people live longer and these surgeries become more common, it is important to identify solutions that maintain or improve outcomes while decreasing the burden on patients and providers.”

The NJM study also points to the challenges of creating a bundled payment program that will show some savings. While the program for knee and hip replacements saw moderate success, Barnett and his colleagues reported that bundled payment programs targeting other therapeutic services didn’t move the needle on cost savings.

“You’ve got to know the business,” Stephen Lucey, MD, an orthopedic surgeon with Greensboro, N.C.-based Delta Joint Management, told mHealthIntelligence in an Aug. 30, 2018 interview. “Telehealth offers tons of opportunity for improving care, but you need to know how to fit it in.”


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