I. Tower Health is Participating in 11 Bundled Payment Episodes 

Tower Health (TH) has been participating in the Bundled Payments for Care Improvement (BPCI) Advanced program since October 1, 2018. BPCI Advanced is a voluntary CMS program in which hospital and physician groups select clinical episodes to manage as a 90-day bundled payment. The model aims to support providers who invest in practice innovation and care redesign to better coordinate care, improve quality of care, and reduce expenditures while improving the quality of care for patients. Tower Health hospitals are participating in 11 episodes across five hospitals, as detailed in Table 1. 

Table 1: Participating Bundled Payment Episodes
Hospital Participating Episodes

 Brandywine Hospital (BH) 

» COPD 

» Sepsis 

Chestnut Hill Hospital (CHH) 

» Sepsis 

» Major joint replacement of the lower extremity (MJRLE) 

Phoenixville Hospital (PHX)

 Sepsis 

Pottstown Hospital (POH)

» Simple pneumonia 

» COPD

Reading Hospital (RH)

» Sepsis 

» Percutaneous coronary intervention (OP) 

» Acute myocardial infarction 

» Spinal fusion

Jennersville Hospital will be eligible to participate in BPCI Advanced on January 1, 2020 and will select episodes for participation later this year. In addition, Tower Health hospitals currently participating in the program will also have an opportunity to add more episodes (effective January 1, 2020). 

II. TH Physician Champions Provide Crucial Program Support 

Physician champions are critical to not only supporting implementation of BPCI Advanced but also driving engagement across care teams. System-level physician leads and hospital-level physician champions have been identified by senior leadership to provide clinical advice and feedback, disseminate information, and manage process changes. Should you have any questions or concerns about the program, please do not hesitate to reach out to any of the physicians identified in Table 2 or the Tower Health BPCI-A physician champion, John Casey, MD. 

Table 2: BPCI-A Episode Physician Champions
Episode System Lead(s) Hospital Champions
Cardiac    
 

Eric Elgin, MD 

Christine McCarty, MD 

Rajiv Dhawan, MD (Phoenixville) 

John Shenouda, MD (Phoenixville) 

Eric Elgin, MD (Reading) 

Neurology  

 

   

Thomas Psarros, MD (Reading) 

Lisa Leschek-Gelman, MD (Reading) 

Orthopedics    
  John Casey, MD  Matthew Lorei, MD (Chestnut Hill) 
Pulmonary    
  James Kim, MD 

Robert Satriale, MD (Brandywine) 

Marc Diamond, MD (Chestnut Hill) 

William Shapiro, MD (Chestnut Hill) 

An H. Pham, MD (Pottstown) 

Navneet Sharma, MD (Pottstown) 

Sepsis    
  Debra Powell, MD

Raida Rabah, MD (Brandywine) 

Lee Jablow, MD (Chestnut Hill) 

Raymond Kovalski, MD (Phoenixville) 

Christopher Martin MD (Phoenixville) 

Lori Lorant-Tobias, MD (Pottstown) 

Debra Powell, MD (Reading) 

III. Bundled Payment Governance Structure Is Key to Program Success 

In order to effectively operationalize and manage BPCI Advanced, TH has deployed a comprehensive governance structure that supports care redesign at the local level through clinical effectiveness teams (CETs), as shown in Figure 1. CETs design and implement episode-specific initiatives related to acute care, post-acute care management, quality, data/IT, provider engagement, and gainsharing. Hospital administration and physicians/providers are equally represented within each committee. To support the program, hospital Joint Operating Committees (JOCs) are actively meeting on a quarterly basis to review episode performance, determine resource requirements, and make any “course corrections” as needed. 

Figure 1: Tower Health Bundled Payment Clinical Effectiveness Teams Structure 

Chart displaying the structure of the bundled payment clinical effectiveness teams

IV. Care Redesign is Critical for Achieving Savings 

Since the beginning of the program, clinical effectiveness teams (CETs) have been actively working to redesign care across bundled payment episodes. Care redesign is necessary to ensure processes are standardized, efficient, and evidence based. As appropriate, activities may include development of care process maps, clinical pathways, and new and/or updated order sets. A progress report for each clinical redesign CET is provided in Table 3. 

Table 3: Progress Report by Episode
Episode Status
Sepsis  
Brandywine Hospital Slightly Behind 
Chestnut Hill Hospital Not Reported 
Phoenixville Hospital On Track
Pottstown Hospital On Track
Reading Hospital  Mostly on Track
Pulmonary  
Brandywine Hospital Mostly on Track
Pottstown Hospital Mostly on Track
Cardiac  
Phoenixville Hospital Slightly Behind
Reading Hospital On Track
Neurology  
Reading Hospital (Spinal Fusion) On Track
Reading Hospital (Stroke) On Track
Orthopedics  
Chestnut Hill Hospital Slightly Behind

V. Greatest Opportunity: Post-Acute Care (PAC) Utilization 

On average, post-acute care (PAC) expenditures account for more than 60% total episode spend. There is significant opportunity for TH to reduce cost during this phase of a clinical episode. Simply, the PAC CET is working to ensure patients are discharged to the “right place at the right time.” The group is actively meeting as a system to develop standardized processes related to the following: 

  • Appropriate discharge placement 

  • Streamlined care transitions 

  • Evidence-based care management workflows 

The PAC CET has been in place since 2015, when Reading Hospital began preparing for participation in CMS’s mandatory joint replacement bundled program (known as CJR). Its efforts to date have been impressive: patients discharged to home increased from 36% to 69%, patients discharged to an acute rehab facility decreased from 8% to 0%, and the percentage of patients discharged to a SNF decreased from 25% to 18%.(1) The PAC CET is working to achieve similar outcomes for the BPCI Advanced program.

VI. Post-Acute Care (PAC) Network Closes the Gap 

A critical component of the TH’s success will depend on the development of a strong post-acute care (PAC) network. Over the past six months, the PAC CET implemented a rigorous process to identify a preferred network of high-quality post-acute care providers. The PAC CET considered 82 providers and selected only 14 to join its preferred network (see Figure 2). The following factors were considered in selecting providers: 

  • Star rating 

  • Volume 

  • Average length of stay 

  • Average payment 

  • Readmission rate 

Figure 2: Preferred Post-Acute Care (PAC) Network
  Brandywine Hospital  Chestnut Hill Hospital  Phoenixville Hospital Pottstown Hospital Reading Hospital
Skilled Nursing Facilities (SNFs)

Tel Hai Retirement Community 

The Inn at Freedom Village 

The Hill at Whitemarsh

PowerBack Phoenixville Rehabilitation 

Rehab at Shannondell 

ManorCare Health Services–Pottstown 

Sanatoga Center

Transitional Subacute Unit 

The Highlands at Wyomissing 

Phoebe Berks 

The Lutheran Home at Topton 

ManorCare–Sinking Spring 

Mifflin Center

Home Health Agencies (HHAs)

Tower Health at Home 

Brookdale Home Health Philadelphia 

BAYADA Home Health Care 

Tower Health at Home 

Southeastern Home Health Services 

VNA Health System

Tower Health at Home 

TriCounty Home Health & Hospice 

BAYADA

Tower Health at Home 

TriCounty 

BAYADA

Tower Health at Home 

BAYADA

VII. In the Spotlight: Sepsis Clinical Effectiveness Team Meets as a System 

The clinical effectiveness teams (CETs) are actively meeting at their respective hospital-levels to streamline care and redesign clinical processes. However, the Sepsis CET is actively meeting as a system with all hospitals participating to share experiences, troubleshoot issues, and maximize economies of scale. System-wide meetings are recommended as a best practice for all CETs across Tower Health. 

 

 

  1. Represents Medicare population for patients discharged with MS-DRG 469 or MS-DRG 470 during the period January 1, 2016 – December 31, 2018.  
Tower Health Providers