S1221 Bundle Payments for Care Improvement in Patients With Gastrointestinal Hemorrhage: Reducing Costs and Readmission Rates at a Single Hospital Center

Abstract

INTRODUCTION: As Medicare promotes value of care-based reimbursement through novel initiatives, bundle payments for care improvement (BPCI) are approaching the forefront. The primary drivers of increased costs in this system are readmissions and post discharge rehabilitation facilities. To date, standardization of care (SOC) in medicare patients enrolled in BPCI for gastrointestinal bleed (GIB) has not yet been reported. We implemented an evidence-based SOC aimed at reducing 90-day hospital readmission rates and healthcare costs for Medicare patients admitted for GIB. METHODS: Our institute implemented a multidisciplinary team to standardize care from initial hospitalization to post discharge follow up for Medicare patients being admitted with GIB. A daily email from the data-analytics team identifying these patients is distributed. A standardized protocol including GI evaluation within 24 hours, blood transfusion, pre/post endoscopy protocol, and medication reconciliation is initiated. Physical therapy evaluates the patient prior to discharge. Upon discharge, patients receive detailed instructions, medication counseling, and follow up with primary care physicians and gastroenterology. For patients discharged to home, care navigators conduct home visits. Data including patient demographics, endoscopy reports, discharge disposition, and changes to medication regimens were collected. We then assessed our interventions’ impact on readmission rates, disposition, and cost in this patient population. RESULTS: 100 patients with the diagnosis of GIB were reviewed prospectively from October 2018 through March 2019. 93% of patients had GI consultation of which 97.8% were seen within 24 hours. Of all endoscopies performed, 93% were done within 48 hours of admission. In aggregated Medicare data, 54 of these patients were enrolled into PCBI. The 90-day readmission rates fell from 41.3% to 27.8% with home discharge rates increasing from 84.4% to 85.2%. In addition, enrolling in this program reduced cost of care, generating a $99,000 gain. CONCLUSION: Two areas of opportunity for cost savings in bundled payments are post discharge disposition and readmission reduction. Involvement at a multidisciplinary level with focus on early identification, improving efficacy, and optimizing resource utilization were all important for achieving quality care and reduced expenditures. Further improvements can be made by investigating readmission patterns in patients with GIB to identify areas in need of intervention.Figure 1.: Chart depicting pathway of care in patients enrolled in the PBCI.