Abstract T P248: All Wrapped Up in a Bundle: Aultman Hospital’s Journey with the Bundled Payment for Care Improvements in Stroke

Abstract

Background: In January of 2013, Aultman Hospital was selected among 500 hospitals nationwide to participate in the CMS Bundled Payments for Care Improvement (BPCI) Initiative. The hospital chose to participate with this initiative using the stroke patient population during the acute hospital stay and services up to 90 days after hospital discharge. During the discovery phase, data was analyzed that helped to identify opportunities within the transitions of care across the continuum for stroke patients. Purpose: To identify areas of opportunity to improve transitions of care across the continuum for stroke patients under the bundled payment initiative. Methods: A multi-disciplinary steering committee, driven by engaged physician champions, came together to review the analyzed data and identify care coordination opportunities. Reviewed data included stroke patients from 2008 to current, with a strong focus on readmissions and complications of care. Data analysis was performed internally by the steering committee and externally by Brandeis University. Results: The committee was able to identify trends in readmissions, potential quality and financial opportunities, create a stroke opportunity matrix and stroke bundled payment dashboard, and enhance the partnership between Aultman Hospital and Aultman Post-Acute Care by creating a Continuum of Care Collaboration Plan for stroke patients. A potential nurse navigator was also identified as a possible need. The position would provide a consistent person(s) that would ensure that individual needs are met across the continuum and possibly prevent readmissions. The team was also able to provide feedback to CMS regarding the BPCI, which ultimately were consistent with the changes CMS made to proposed data collection and reporting requirements. Conclusions: Throughout Aultman’s journey with the BPCI, common themes remained: the need for collaboration of services for stroke patients to ensure continuity of care and to streamline the encounter for the patient. Aultman’s BPCI for Stroke team was able to identify ways to reduce readmissions, prevent complications of care, explore the potential for a stroke nurse navigator, and reduce the overall financial impact to an overburdened public health system.