The compensation for medical procedures is undergoing a major change. Medicare is driving the change followed closely by the insurance companies.

The basic concept is changing from “fee based” to “value based”. The orthopedic practices are leading the change, and they will eventually be followed by all practices.

Hospitals and Ambulatory Surgical Centers (ASC) will now have their compensation tied not only to the procedure itself, but also for the results associated with the following 90 day recovery period.

Now the question becomes – How do hospitals and ASC more cost effectively monitor Transitional Care Management (TCM)?

Clearly there will be periodic clinician visits either in the office or at the patient’s home. However, the total time with each patient is limited and this process is fairly expensive. More importantly, is it sufficient to capture “unexpected” changes in condition?

In many cases, these same patients will also be using home caregivers. Normally they will be with the patient for longer periods of time and will be able to observe day to day changes. Is there some way to capture and use their observations? Is that capture valuable?

Harvard Medical School recently reviewed the preliminary data from a home caregiver pilot program¹. In that pilot, caregivers were tasked to report any “changes in condition” with their care recipients. The HMS review pointed out many positives, including “relatively few false positives”.

Though this particular pilot program did not focus exclusively on post surgery recovery, could the results for Transition Care Management be even more positive?

Home Care LINK (HCL) has developed an approach for all caregivers to record changed condition observations. These observations are automatically sent to our cloud based server following each caregiver visit. These time based observation reports are immediately available for each care recipient.

For TCM, Home Care LINK software permits the hospital or ASC Case Managers to specify the specific conditions to be monitored. The caregiver then records their observations based on those conditions.

Now, more questions:

• How do Case Managers take advantage of these observations?
• Will this approach improve patient outcomes?
• Will it reduce hospitalizations and reduce overall medical costs?
• Will this approach reduce a hospital’s or ASC’s financial liability?
• Should this capability be a prerequisite for a recommended Home Care Agency?
• Is there a way to test the value of this proposition?

We are looking for a hospital or ASC to assist in evaluating this potential?

1. “Preliminary Data on a Care Coordination Program for Home Care Recipients”, The American Geriatrics Society Journal, August 2016.