Health programs may bring money to Vt. providers
By David Taube
VERMONT PRESS BUREAU | October 08,2012
New health care initiatives are gradually being implemented across the state, but health care providers could soon find out if they will be rewarded for them financially.
If federal applications are approved, health care partnerships in Vermont could see financial rewards based on the performance of their programs.
One such initiative is a pilot project by Rutland Regional Medical Center, which seeks to reduce the number of patients readmitted to the hospital for congestive heart failure.
“The problem has been patients will go into the hospital, they’ll be treated in the hospital, they may have to go into the nursing home … and then they might have an acute episode of their congestive heart failure in the nursing home,” said Richard Slusky, director of payment reform for the state’s Green Mountain Care Board.
“The nursing home lacks the resources to treat the patient … so they get referred back to the hospital, so you have a readmission to the hospital for the same condition that they had been treated for (recently),” he said.
The federal government soon could approve RRMC’s program, one of several new health care models in the state, helping shift the industry away from the current fee-based system to value-based initiatives that reward health care providers based on quality and reductions in expenses.
RRMC’s partnership involves three nursing homes, The Pines at Rutland, Mountain View Center and Rutland Healthcare & Rehabilitation Center; two home health-care agencies, the Rutland Area Visiting Nurse Association & Hospice and BAYADA Home Health Care; and the primary physician group Community Health Centers of the Rutland Region.
The agreement is currently nonbinding.
If the Centers for Medicare & Medicaid Services, known as CMS, approve the program, the hospital and other providers would receive the same amount of money from Medicare per average case, but if the provider group found any savings through working together, they’d get to keep that money.
If expenses exceed that average, the partnership — not Medicare — is responsible for the costs. The hospital will be the sole partner to assume that risk, according to RRMC’s vice president of quality improvement, Darren Childs.
As part of the program, RRMC hopes to reduce a readmission rate for congestive heart failure cases, from a 24 percent monthly average to 18.5 percent. The program hopes to find about $60,000 or more in savings each year. Those savings would be redistributed to participating providers based on historical data.
A team of participating partners has been meeting each month and plans to implement team-based improvements even if the application is not approved, Childs said. The hospital submitted the plan to CMS on June 28.
“This is part of the change that needs to be made in health care,” Childs said. “We’re really working better than ever before ... to take care of our patients and to keep people well and as healthy as they can be.”
The Rutland hospital has some 125 cases of heart congestive failure each year. If the pilot program is successful, programs for other health conditions could follow suit.
The program does not affect the cost of care for patients, Childs said.
Another Rutland project that’s been in discussion for some six months is a global budget initiative — which would pay primary-care physicians for better coordinating care with specialists at RRMC. If expenses like an overuse of services are reduced, partners in the project could share those accrued savings.
Throughout the state, other pilot projects hope to distance the industry from a fee-based model.
One statewide partnership with all but one of the Vermont’s hospitals and 58 physician groups, as well as various health care centers, seeks to gather Medicare patients into one system, called an accountability care organization or ACO.
“The bigger the patient population you have, the better off you are” said Susan Kruthers of Central Vermont Medical Center in Berlin. “It’s kind of like health insurance — the more people you have, the more likely you are to sort of come out even in the end.”
CVMC has programs in place that the new model could affect. One class at Montpelier Integrative Family Health on sensible eating hopes to have students make major commitments in order to improve preventative health care.
Medicare patients’ access to services will remain the same, Kruthers said. “From a patient’s perspective, nothing is going to change,” she said.
With similar pilot projects, if savings are generated, participating providers get to keep accrued savings. After an initial three-year introductory period, penalties would occur on the provider side, Kruthers said.
The application for the accountability care organization, headed by Fletcher Allen Health Care in Burlington and Dartmouth-Hitchcock Medical Center in Lebanon, N.H.,was submitted in early September, and the system could go into effect Jan. 1.