In recent months, orthopedic leaders have expressed growing concerns surrounding the ever-expanding regulatory requirements that their care teams have to fulfill. Significant variation in experience in value-based care (VBC), bundled payment models, or effective patient-reported outcome (PRO) collection has resulted in a frenzied rush to implement solutions and processes to avoid financial penalties and raise the quality of patient care.
Our team decided to host a Q&A discussion with Force experts who engage with some of the leading orthopedic care teams and executives in the country daily so that they can share best practices and insights into optimizing workflows with digital care to succeed in this regulatory environment. Force Therapeutics CEO Bronwyn Spira hosted this panel discussion, which included our President Mark Lieberman, Director of Client Success Alex Fierens, and Senior Product Manager Zach Friedenreich.
The discussion focused on the role of digital care in current and future regulatory mandates from the Centers for Medicare & Medicaid Services (CMS), including the total hip and knee arthroplasty PRO performance measure (THA/TKA PRO-PM) in quality reporting programs and the newly proposed Transforming Episode Accountability Model (TEAM), which is outlined by CMS here.
Below are excerpts from some of the most impactful sections of the discussion.
Missed the panel? Access the full recording here.
What have been the biggest challenges for orthopedic organizations surrounding the CMS PROMs mandate?
Alex Fierens: There's a variety of factors that are going to impact organizations, depending on their size, their complexity, and the resources that they have assigned to collecting PROMs. However, the biggest and most consistent issue that I'm seeing across the board as it relates to this mandate is really the collection of that 1-year PROM and that has to be at 50%, as you mentioned, to ensure successful reimbursement from CMS.
So pre-op is easy, right? I think this is something that can be done through an EMR, and it can be collected on paper when patients are coming in to be scheduled for surgery or even the day of surgery if necessary. However, it's the PROM at the 1-year mark where they are not really seeing those results. I think a lot of our customers have told us that their EHR 1-year PROMs compliance sits at about 20%-30% right now, which is well below what we need to meet that 50% threshold.
Oftentimes. I'm also seeing organizations spending money on 2 to 3 full time resources who are then calling patients manually trying to get these forms completed. This isn’t only cumbersome; it's super manual, and it's still not yielding that 50% compliance threshold that is necessary for successful reimbursement.
How are hospital and health system executives planning for these mandates and regulatory requirements?
Mark Lieberman: We're generally seeing 3 different approaches. The early adopters have put in place these comprehensive plans for digital patient care, digital education, and automation around their approach to PROMs. It really helps them instrument their business and clinical operations better. And we're seeing that these same hospitals are now really nicely set up for the PROM mandates and mandatory bundles that are coming, and they're running their business with sort of the theme of operational excellence as their overarching North Star. These groups were prescient in predicting that the regulatory environment would ultimately drive incentives to quality and tie those incentives back to their ultimate reimbursement.
The second group are actually smartly leveraging the PROMs mandate right now to justify internally that very hard decision to make some transformational changes to clinical workflow and the monetization of their care. And they're doing this through the lens of let's now do this to make sure we avoid these penalties. And there's other great benefits to it. And this is how they're justifying those investments internally. They really just needed a catalyst to make some of these changes happen. And this is really the catalyst to do so.
The third group represents the majority. And this is where we see no strategy in many of the hospitals that we're talking to today. There's a scramble to put in place a solution. And that scramble includes, you know, let’s hire more people…let's brute force our capability to meet these mandates with data collection by adding more people. Let's leverage the EMR that's connected to the patient.
While most hospital leaderships are engaged in this topic, they're really all over the map. And I think, hopefully, many more of them fall into camps one and two over time.
How do you ensure providers and patients on Force are getting the best experience possible while still meeting those data collection and reporting requirements?
Zach Friedenreich: Being that we serve both patients and providers, we have to balance the unique needs of both personas when we think from a product development standpoint.
Our approach to the product development process is truly data informed and data driven regardless of which persona we're talking about. And we think about that from both a qualitative and quantitative data standpoint. First and foremost, we're always in constant communication with both our patient and provider users to ensure that we're hearing them and understanding where their problems and challenges lie so that we're always providing true value against their ever evolving needs. Things in healthcare change very quickly, and we want to make sure we're staying in touch with those folks. Our teams are also always monitoring and analyzing product usage data on both the patient and provider platforms as a means of identifying any sticking points or gaps in the way that folks are using our platform so that we can attack those opportunities extremely efficiently and effectively.
Our platform’s intelligent care plans are built to enable customizable patient experiences at scale, which is an extreme challenge in the healthcare world right now. This was something that our teams have developed over many years at this point, and it's really kind of the underpinning of the force platform and tries to deliver against creating really engaging and valuable experiences for both patients and providers who have very different needs. This suite of functionality also kind of mitigates that urge to throw people at the problem, which is something that I think both Alex and Mark sort of alluded to in their previous responses.
How are healthcare executives thinking about quality and PROMs in the context of the new TEAM mandatory bundles?
Mark Lieberman: A major theme that we are hearing is really best described as a path to operational clinical excellence. They're asking how do we optimize the productivity of our limited staff to execute patient care at scale? Each of these new regulatory requirements adds work to an already strained system. And the answer, you know, is to have that coherent technology strategy in place. But now you're also layering on top of it value-based care initiatives and quality mandates. It's getting really hard.
As you stated, the goals have really not changed in terms of how these hospitals are measuring success: reducing length to stay, reducing readmissions, lowering complications, making sure that they're collecting patient data, lowering the overutilization of post-acute care. All of these are important to be able to operate in a value-based care environment.
The next level, though, is to do all of this while actually hitting your quality benchmarks and your patient care experience benchmarks. And so we are seeing a view that really when we can provide a patient with convenience and quality and cost savings and leverage the existing staff at scale and eliminate their manual tasks…that's really helping them to think about running their hospital system in this new regulatory environment and being able to do so profitably, but also in a way that's best for their patients.
How do we keep our platform compliant with current requirements but also flexible to meet new regulations?
Zach Friedrenreich: This is a really important question because in this space, you can fall behind rapidly if you’re not up to date with these evolving regulations. And we’ve built out our product to allow for that flexibility. Mainly because we have a really strong, robust understanding that the healthcare landscape is changing on a daily, weekly, monthly basis. That understanding comes from 2 main things.
First, we have hundreds of providers using our platform every single day, and we really have the opportunity to interface with them, understand their needs, look at their workflows and see where things are kind of breaking down and where they need support.
Because we have that direct interface with these individuals, we're able to partner with these organizations to adapt to their workflows, or understand that they're participating in a new registry or the CMS PROMs mandate, allowing us to take action against those specific circumstances really effectively.
The second thing that I want to note here is that Force is really unique in that we have many clinical experts across our various teams, whether that's directly on our clinical team, client success team, or the product team. We can leverage these individuals and their understanding of the healthcare landscape to inform what's coming so that we can take action against those insights incredibly fast and stay ahead of the curve.
On top of that, we're really lucky to have our clinical team who are able to build these evidence-based gold standard protocols that they're constantly updating based on new regulations and research evidence.
How does the addition of the quality element in TEAM affect the care teams you work with everyday?
Alex Fierens: So the emphasis now is on not only the quality of care, but your cost containment in your ability to do so. So essentially, what they're asking you to do is more with less. And the way that I think about that impacting providers today is really shifting a lot of those workflows from reactive to proactive.
What I mean by that is, you know, I think logging into your EHR every day, seeing who's having surgery, maybe calling every single one of those patients..this is not necessarily the best way to be efficient and scale those provider resources to spend time with the patients who need it most. With Force, there's kind of a two-pronged way that we really help address this situation.
The first of those is patient education, and this is really important for two reasons: First, we know from literature that a better educated patient is much less likely to have poor outcomes. They're much better educated, and they're likely to have less variance in cost with the delivery of that care.
The second piece is, if you're able to educate patients at scale, you're also able to scale the care providers time so that they can then use that time on those patients to manage those quality outcomes in real time. And an example of this is, we actually work with a large academic medical center in the northeast, and they used to get 30 calls a week about post-operative bruising typically around day 2 or 3. So we were able to take that organization's unique challenge, and we actually pushed patients a picture of a hip on day 1 post-op saying “this is very normal, or this is likely what you're going to experience.“ And we were able to take that down from 30 phone calls a week to 2.
And then the next part of that is what do you do with that time that's given back to that care team? And I think you want to use that time proactively, you want to spend that with the patients who need that most. And an example of how we've done this at Force is we have an amazing preoperative questionnaire that we ask patients in terms of whether they feel prepared for surgery? Do they understand their discharge plan? Do they feel comfortable with post-op pain management?
So when care providers log in, they can see any patients who've answered negatively. They can drill down into those lists, and they can prioritize those patients who are more likely to have poor outcomes based on those responses. And there's also alerting that we can, you know, practically identify patients for those providers without having to log into the platform. And those alerts aren't limited just to pre-op preparedness. That could be a spike in temperature, pain, or range of motion. So we really want to work with your organization to understand how we can educate your patients to free up your time? And then with that time, what are the things that you want to know about these patients? And how can we alert you to spend the time with those who need you the most.
Access the full recording here.
