For bundled-payment systems, physicians need to change the way they think, says an article in NEJM Catalyst. Among the recommendations:
“Assume leadership of the ‘next site of care’ decision during hospital discharge planning.”
“Physicians can no longer default to the discharge team — case managers, physical therapists, nurses, and social workers — when deciding on the next site of care. Instead, physicians will be called upon to be the team leader as next site of care planning is carried out. This involves understanding the patient needs that determine the most appropriate next site of care and grasping the differing capabilities of home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term acute care hospitals (LTACs).”
“Ensure that patients are mobilized early and often.”
”Regardless of a patient’s principle diagnosis and co-morbid illnesses, functional status has a major impact on recovery. During hospitalization, patients remain in bed too often, as the staff focuses on delivering medications and other treatments. The deleterious effects of immobility are well documented. Bundled payment models provide new incentives to avoid keeping patients in bed needlessly, as immobility and deconditioning increases the chances for facility-based care after discharge.”
”Ensure that patients’ goals of care are elicited, and when appropriate, palliative or hospice care is delivered.”
”Physicians must have the conversational skills to draw out patients’ goals of care, especially where advanced or severe chronic illness is involved. Patients are often relieved when their physician brings up the matter of care goals. In some cases, onerous interventions like hospitalization, emergency room visits, or procedures may be avoided in keeping with a patient’s wishes.”
To read the whole piece, please hit this link.