Healthcare Snapshot - August 2024
August 01, 2024
CMS Releases Mandatory Bundled Payment Model: TEAM
The Inpatient Prospective Payment System (IPPS) Final Rule was released earlier this month, finalizing the details of the new Transforming Episode Accountability Model (TEAM). TEAM is set to begin on January 1, 2026.
TEAM is a mandatory payment model that will be tested in certain Core-Based Statistical Areas (CBSAs) across the country. The model will focus on the total cost of care for certain inpatient procedures and a 30-day period following the procedure. As the model progresses, participants will be required to participate in downside risk.
CMS has stated that there will be an application opportunity for organizations that do not operate within the selected CBSAs. CMS will also allow a glide path opportunity for organizations within the selected CBSAs that are currently participating in the Bundled Payments for Care Improvement Advanced (BPCI-A) Model.
Groundbreaking Study by Dr. Shannon and Dan Reck on Chronic Kidney Disease
Our Chief Medical Officer, Dr. Michael H Shannon, and Dan Reck, Director of Actuarial Services at MultiCare Connected Care, have co-authored an important study published in the Journal of Managed Care & Specialty Pharmacy (JMCP). Their article, "Benefits of Dapagliflozin in Chronic Kidney Disease for US Commercial Payers: A Cost-Offset Analysis," provides valuable insights into the economic and health benefits of dapagliflozin for patients with chronic kidney disease.
This research highlights the potential for cost savings and improved patient outcomes, making it essential reading for healthcare professionals and industry decision-makers.
Patient Success Story
After a successful discharge from the Skilled Nursing Facility (SNF) on July 3rd, a beneficiary faced significant challenges related to his recent C4-C7 laminectomy, including managing his catheter. The PSW Nurse who was preparing to reach out to the beneficiary quickly identified that home health services were delayed and recognized the potential risks this posed.
Understanding the urgency, she immediately reached out to ensure the beneficiary’s needs were addressed, bridging the gap in his care during this crucial transition period. The beneficiary, who had been struggling with discomfort and symptoms indicative of a urinary tract infection (UTI), was initially concerned as his last check before discharge was negative for UTI. However, thanks to the prompt coordination by The PSW Nurse, a referral to a urologist was placed through his primary care physician (PCP).
On July 5th, within just a few hours of outreach, home health services responded, confirming the UTI and identifying a bacterial wound infection. The beneficiary was started on antibiotics, and with diligent follow-up care, he began to experience significant relief from his symptoms.
By July 10th, after a series of follow-up visits and continuous support from his healthcare team, the beneficiary's condition had improved markedly. His symptoms of pain had resolved, and he no longer required nursing assistance for his catheter. Through the combined efforts of the healthcare team and the beneficiary's own commitment to his recovery, he regained his independence and confidence in managing his health. This story is a testament to the power of proactive care and the importance of seamless transitions in ensuring patients not only recover but thrive.
