As healthcare welcomes in the new decade, leaders are prioritizing reinvestment in orthopedics and other key service lines to scale success and win new markets. Allocation of these investments, however, is changing with the industry. The Force team has identified three key trends for hospitals and health systems to consider while looking into 2020 and beyond.
- 1. Growing demand for orthopedics, especially in the outpatient setting
- 2. Continuation of alternative payment models such as bundled payments
- 3. Payer demand and provider adoption of digital health
1. Make room for more patients.
As of January 2020, both total hips and total knees are off CMS’s inpatient-only list, meaning surgeons and their care teams are free to shorten hospital visits and, if there’s access, shift volume to ambulatory surgery centers (ASC).
Why it’s happening:
According to Industry Research Orthopaedics Status and Forecast, the global orthopedics market reached an all-time high in 2019, with North America accounting for 44% of the industry, and is expected to grow for the next 7 years with a CAGR of 4.4%. Health systems are scrambling to enable more capacity by hiring additional staff and consolidating with other facilities. Excess pressure on clinicians to cut costs and increase efficiency across the continuum is leading to an uptick in outpatient surgical procedures; a highly effective method of delivering value (if done correctly!).
What it means for you:
Organizations must quickly engage physicians in meaningful and mutually beneficial ways to advance the goals of all stakeholders. For example, innovative hospitals are creating joint ventures with physicians to build ASCs and providing technology to scale care teams. Administrators are allowing surgeons to drive site-of-service strategy and providing them with the necessary tools to make it safe and efficient. To learn more about bridging the physician-hospital gap, check out our latest webinar with the Connecticut Joint Replacement Institute at Saint Francis Hospital.
2. Win the bundle. Win the market.
CMS welcomed in a new cohort of participants for BPCI-Advanced, which included 621 new sites. The final year of the CJR program is officially underway, and health care leaders are retrospectively compiling evidence to continue a form of the program. Between 2018 and 2019, there was a 50% increase in the number of employers contracting directly with centers of excellence with their own form of ‘at-risk’ payment models.
Why it’s happening:
Bundled payments work. After years of implementing and iterating, CMS is now retrospectively analyzing the success of their alternative payment models. Here are some stats:
- 3.7% decrease in CJR episode payments , representing a $146.3 M gross savings
- $128.9 M CMS distributed CJR reconciliation payments to hospitals
- 77% of participants received CJR reconciliation payments (sites that were successful)
- $1,630 average decline in BPCI episode costs
- No negative impact to quality in either model
What it means for you:
Employers and the large purchasers of healthcare are noticing the impact of bundled payment models and negotiating contracts only with providers that can demonstrate their commitment to value. If you didn’t participate in one of CMS’ earlier models, look to systems that did for guidance. For example, over 40% of episode costs exist in the post-acute, which is exactly where the majority of cost savings came from for CJR and BPCI.
3. Get on the digital health bandwagon.
According to the 2020 Large Employers' Heath Care Strategy Survey, nearly 75% of employers view virtual solutions as having a significant impact on healthcare delivery in 2020. And, with the growing digitization and consumerization in healthcare, payers are beginning to further incentivize providers to adopt technology with payments specifically for virtual patient check-ins.
Why it’s happening:
Patients and payers are demanding predictable cost and quality, and technology is the gateway to both. Digital health platforms, such as Force, have been studied and validated in clinical settings as a solution to reduce cost and quality variation without additional staffing or brick & mortar.
What it means for you:
There’s no way around it. Virtual care continuums are the future and providers should develop their own best practices for incorporating digital solutions into their key service lines. When evaluating a technology, be sure to understand the value it will bring to your unique organization and patient population. Most solutions today still lack the personalization and configuration needs that your patients and clinicians desperately need.To learn more about how leading institutions are taking advantage of these trends, reach out to the Force team for a consultation at learn@forcetherapeutics.com
