Increasingly in recent years, providers and payers throughout the nation have been exercising value-based care principles through initiatives such as the Bundled Payment Care Initiative (BPCI). Physician leadership and engagement are vital elements of physician group practices’ success in BPCI, resulting in higher scores on many key performance indicators.
Dr. Ken Kaminski, an orthopedic surgeon at Azalea Orthopedics and Sports Medicine, a BPCI participating physician group located in Tyler, TX, exemplifies clinical integration and physician leadership.
Dr. Kaminski specializes in primary and complex hip and knee replacements, revision joint surgery, and painful joint replacements and performs 750 joint replacements annually. He believes that bundled payments are important to implement because the fee-for-service environment is unsustainable.
In the following series of questions, Dr. Kaminski provides his insights on the benefits and challenges of care redesign. Through his answers, we gain insight into the physician and practice perspective of BPCI implementation, particularly regarding strategies for addressing physician resistance to change.
Why do you think physicians should be excited about programs like BPCI?
I’ve been hearing for years from my fellow surgeons how we as physicians are continuing to lose more and more control over patient care. Well, here’s your opportunity to retake your control and quality the way it should have been; you need to get engaged! Fee-for-service is unsustainable and this is your opportunity to do something different.
How did you convince your partners to get on board with BPCI and to continue to stay engaged?
Signature Care Management helped a lot with this piece. Signature was able to bring the data to the table, and you can’t argue with the numbers. It was shocking to see some docs’ numbers – length of stay in skilled nursing facilities and overall episode cost. Peer pressure is powerful, so we used physician report cards to show who was doing well and who was making improvements.
When we first implemented, we had a board meeting every other week. A ton of communication. When we got our first check as a result of the savings that helped with engagement!
Signature continues to share best practices that we can work to implement and that keeps us engaged.
What was the most common resistance to implementing BPCI and how did you address it?
There is a misconception that bundled payments encourage providers to withhold care. It’s really the opposite. Through the use of case management services, we are working hard to provide an individualized care plan based on a patient’s specific needs. Pinpointing high-risk patients lets orthopedic surgeons know who may need more detailed follow-up post-surgery to assure there are no complications.
What have been your greatest successes in bundled payments?
With bundled payments, we have seen faster recoveries, reduced readmissions, and more physician control over what is happening post-operatively. The clinical experience is better now that skilled nursing has been reduced.
We know competition and comparative data can spur action and behavior change. How has the access to real-time data in CareMOSAIC impacted your success in BPCI?
At our practice, BPCI case managers visit with the physicians individually to discuss data and talk with them about opportunities for improvement. Transparent and frequent communication between the case managers and physician leaders is one of the keys to successful BPCI implementation. The ability to integrate real-time data from CareMOSAIC before we have access to claims data promotes preemptive change as well. The data and constant feedback about financial performance that Signature provides us is a huge motivating factor for our physicians.
Many physicians have a strong belief in the value home health provides patients post-op. You have reduced HH utilization by a significant amount. What made you start sending all of your patient’s home with OP PT instead of HH?
Many physicians sent their patients home with home health because it’s what they’ve always done. Once they look at the data and see that you can get outcomes that are just as good, or better, from outpatient PT, they understand why the change is necessary.
What clinical thresholds do you have in place and how do you encourage your peers to adhere to those protocols?
We implemented hard stops for patients with a BMI over 40, an A1C over 7.5, and factored in concomitant chronic conditions. Other factors, such as mental health, smoking, and caregiver status, played into the equation.
We encourage accountability among physicians, establishing a BPCI subcommittee to review and discuss outlier cases. We have never had to enforce a monetary penalty on any of our physicians, as peer pressure works well. Overall, improving accountability depends on having shared goals that unite the interests of all. For our practice, that goal is patient satisfaction and performance, striving to return patients to their prior level of care.
Azalea Orthopedic’s success in BPCI shows the importance of physician leadership and involvement such as that provided by Dr.Kaminski. Physician engagement and effective communication are the keys to positive patient outcomes and financial performance for physician group practices. With BPCI Advanced beginning October 1st of this year for 29 clinical episodes, PGPs will need to set themselves up for success from day one. After working with over 55 orthopedic groups in BPCI Classic, Signature has seen firsthand the importance of effective strategies to implement bundled payment programs. Bundled payment programs designed with the appropriate incentives are a win for all parties – patients, physicians, and payers.