University of Rochester Medical Center exec touts bundled payment program on Capitol Hill

James Garnham, director of contract and payment innovation at University of Rochester Medical Center.

Executives at University of Rochester Medical Center are so pleased with how the federal government's bundled payment joint replacement program is working that they want to expand it beyond Medicare, James Garnham, who heads bundled payments for the system, said Monday at a hearing on Capitol Hill.

Within a year, the University of Rochester Medical Center reduced the percentage of patients receiving rehab care for joint replacement at a skilled nursing facility from 74 percent to less than 25 percent. And most patients now receive less expensive care at home, Garnham said.

"You would expect the clinical leaders would all be about hey, let's apply these great resources to more than just the Medicare bundled payment folks," Garnham said during the hearing. "What I didn't expect, I've had just as much attention from the administration of the hospital saying, 'How can we leverage this to other patients? We have a unique opportunity here to really improve the quality of care that we're delivering, reduce the costs that we're delivering. How can we figure out a way to afford this to broaden it out to other populations?'"

[Also: CMS launches bundled payment test for joint replacement]

Garnham, director of contract and payment innovation, had no immediate suggestions for expanding the program, but talked about how the health system was able to bring down the provider's costs for joint replacement and, to a lesser extent, for the treatment of congestive heart failure.

He spoke during a panel titled, "Medicare Payment System Reforms: What Do We Know?" held by the Kaiser Family Foundation and the Alliance for Health Reform.

Other experts on the panel included Patrick Conway, chief medical officer of the Centers for Medicare and Medicaid Services.

Garnham said, from a consumer viewpoint, bundled payment for an episode of care for knee replacement begins when the patient goes into his or her doctor's office and says the cortisone injections are no longer working to control the pain.

[Also: Truven Health finds $10,000 regional difference in bundled spending for joint replacement]

After knee surgery, rehabilitation in a skilled nursing facility makes up the largest portion of the cost of care.

To bring down the cost while keeping the quality of care, Garnham and his team created a unified plan that would lead to post-surgery treatment in the home.

One person, called the care navigator, is the single point of contact for both patient and provider, at the start of an episode of care to the end, he said.

"The real key is the care navigator," Garnham said, "one person who has the focus."

In dealing with reducing costs for congestive heart failure, the hospital was faced with a totally different population.

The goal of reducing hospital readmissions has not been met, Garnham said, except in cases when a patient goes home to a home health provider that is a hospital partner.

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Patients who go home to regular home care have a hospital readmission rate of 43 percent, Garnham said, while those who receive care from a partnering agency have a 17 percent readmission rate.

Eric DeJonge, geriatrics director of MedStar Washington Hospital Center, said the biggest challenge for the home based primary care model is finding enough skilled workers.

Twitter: @SusanJMorse