Novato Community Hospital Pilots Innovative Healthcare Reform, CMS Initiative

The Centers for Medicare & Medicaid Services Announced Participants in Bundled Payment Initiatives Aimed at Raising Quality and Lowering Costs

Feb 04, 2013, 19:35 ET from Novato Community Hospital

NOVATO, Calif., Feb. 4, 2013 /PRNewswire/ -- Novato Community Hospital (NCH) is one of only seven providers in California to partner with the Centers for Medicare & Medicaid Services (CMS) on Model 2 of a new pilot program – Bundled Payments for Care Improvement Initiative. Under this model, NCH will enter into payment arrangements with CMS including financial and performance accountability for episodes of care related to hip and knee replacement surgery. The episode includes the inpatient stay in the acute care hospital and all related services 30, 60, or 90 days after hospital discharge. This is a three-year project aimed at raising bar on quality while lowering overall costs.

"For patients, this means a hospital is coordinating their care in a completely new way—from the moment they enter the facility for joint replacement surgery through the crucial recovery time after they leave the hospital. We monitor their progress if they go home or to a residential rehabilitation center. We ensure they have needed in-home support to transition easily to outpatient physical therapy. We anticipate any issues that might arise and correct them early before they can escalate into serious problems," said Grant Davies, CEO of Sutter Health's North Bay Hospitals, which includes NCH.

"Improving quality and lowering costs is the right thing to do for our patients and our community," Davies continued.

"Novato Community Hospital is uniquely qualified to spearhead this effort because of its robust Orthopedics Program. It includes nine orthopedic surgeons with specialties in sports medicine, upper and lower extremity procedures, total joint replacement, integrated sports fitness and physical therapy, and strong relationships with community providers," Davies added.

The Bundled Payments for Care Improvement initiative includes four models of bundling payments, varying by the types of health care providers involved and the services included in the bundle. Depending on the model type, CMS will bundle payments for services beneficiaries receive during an episode of care, encouraging hospitals, physicians, post-acute facilities, and other providers as applicable to work together to improve health outcomes and lower costs. Organizations of providers participating in the initiative will agree to provide CMS a discount from expected payments for the episode of care, and then the provider partners will work together to reduce readmissions, duplicative care, and complications to lower costs through improvement.

Today's announcement marks the start of Phase 1 of Models 2, 3 and 4. In Phase 1 (January–July 2013), over 100 participants partnering with over 400 provider organizations, will receive new data from CMS on care patterns and engage in shared learning in how to improve care. Phase 1 participants are generally expected to become participants in Phase 2, in which approved participants opt to take on financial risk for episodes of care starting in July 2013, pending contract finalization and completion of CMS' standard program integrity reviews.

"The objective of this initiative is to improve the quality of health care delivery for Medicare beneficiaries, while reducing program expenditures, by aligning the financial incentives of all providers," said Acting Administrator Marilyn Tavenner.

Novato Community Hospital is in the Sutter Health West Bay Region, which provides comprehensive health services for the community stretching from San Francisco and Marin County to Crescent City and Lake County. It includes California Pacific Medical Center in San Francisco, Novato Community Hospital, Sutter Medical Center of Santa Rosa, Sutter Lakeside Hospital in Lakeport, Sutter Pacific Medical Foundation, numerous outpatient centers and the CPMC Foundation, the philanthropic arm of the SHWBR. We strive to provide access to primary care physicians and specialty services in each of our communities, and have a network of over 1,500 physicians locally and over 3,500 throughout the Sutter Health network.

SOURCE Novato Community Hospital