ARTICLE
Presentation (PDF) Open in new window Background • 5% of U.S. Population = 49% of Health Care Spending • 50% of U.S. Population = 3% of Health Care Spending • Fee for Service Rewards High Volume of Patient Visits • Capitation Manages Costs/Visits • How to Reduce Costs and Improve Care and Outcomes • 17% of American adults have comorbid mental health and medical conditions • Only 27% of community hospitals have an organized, inpatient psychiatric unit. (29% of Adults with Medical Conditions also have Mental Health Conditions.68% of Adults with Mental Health Conditions also have Medical Conditions.) • Undetected and Poorly Treated Behavioral Health Needs • Inappropriate ER Utilization • Increased Length of Stay • Increased Readmission • Noncompliance with Clinical Regimens • High Degree of Co-Morbidities with Key Physical Illnesses • High Presumption of Psychotropic Prescriptions by PCP Readmissions • Nearly 20% of all Medicare beneficiaries discharged from a hospital are readmitted within 30 days. • In 2009, CMS estimated that the Medicare patients rehospitalized within 30 days of discharge cost Medicare approximately $12 billion. • Elderly population will increase from 12% to 20% by 2050 • Doubling of numbers and costs in functional impairments for > 65 population. • Doubling of need for long-term services and support Collaboration Between Hospitals and Behavioral Health Providers Traditional Model 1. Patient checks into hospital 2. Patient is treated for medical condition at hospital 3. Patient is discharged without any behavioral health treatment Why is this model suboptimal? • Lack of post-discharge support services • Fragmentation of services • Patient not being adequately treated for entire condition • Higher costs because higher likelihood of readmission Continuum of Care Continuum of Care may include the following services: • Wellness programs • Engagement Services • Outpatient and inpatient services • Rehabilitative and habilitative services • Residential care and supported housing • Acute intensive services Barriers to Effective Care Transitions • Investment in training of staff • Availability of time • Hospitals overburdened already • Reluctance of Hospitals to deal with mental health issues outside of emergency room • Funding • Lack of communication among providers • Different formatting of electronic health records • Confidentiality issues with mental health records • Deficiency of community resources • Lack of support and buy-in from important decision-makers Expectations for Physical-Behavioral Care Coordination • Improved Outcomes • Physical Health • Mental health • Reduced Readmissions • Reduced Impact from segmented delivery system • Effective pharmacotherapy • Telemedicine • Bundled payments Integrated Services Delivery • Three levels of Integration • Coordinated care • Co-located care • Integrated care • Six Degrees of Collaboration See, SAMHSA – HRSA Center for Integrated Health Solutions, March 2013, A Review and Proposed Standard Framework for Levels of Integrated healthcare. Behavioral Health Continuum • Joint Commission Behavioral Health Home Accreditation • Integrating behavioral and physical healthcare • Coordination and integration model • 84 new requirements • Focus on primary care, person-centered, comprehensive and coordinated care Health Homes – A Proxy for the Future? • Population-based integrated care model • Linkages from acute care to primary care to community mental health to social support • Six care services across physical and behavioral health and social services at consumer level • Use of IT for care coordination and remote services Collaboration Between Hospitals and Long Term Care Facilities Long Term Care Issues • Avoiding rehospitalizations • Avoiding poorly executed care transitions • Preparing for transition out of hospital • Preparing for reception into next setting • Preparing for transition into hospital See, Institute for Healthcare Improvement, How To Guide: Improving Transitions from the Hospital to Community Settings to Reduce Avoidable Rehospitalizations; 2012. www.IHI.org. Barriers to Effective Transitions • Delivery system level • Clinician level • Patient level • Funding • Legal (myth and reality) See, American Medical Directives Association, Transitions of Care in the Long Term Care Continuum Clinical Practice Guidelines; 2012. Long Term Care Continuum • Multiple levels of sites of care • Communication and consistency of information and practices • Medication changes • Hospital admission • Hospital discharge • NF patients to hospital ED without essential information Affordable Care Act • Supports Accountable Care Organizations and Patient-Centered Medical Homes • ACOs are groups of health care providers that enter into collaborative agreements to share responsibility to improve quality and control costs • New incentives to facilitate patient transfers • Use of bundled payment rates across acute and post-acute providers “Standard” Legal Issues • Type of integrated relationship and transaction • Control of employees • Policies and protocols • Insurance coverage (general and professional) • Training and discipline of personnel Health Care Legal Issues • Anti-Kickback, Stark, and FMV • Credentialing • Licensing • Health Records • Compliance (regulatory and billing) • Audits • Tax Exemption Conclusion • Communication • Coordination • Comprehensive • Commitment • Care • Compensation Legal Disclaimer Material contained herein is not to be considered legal advice to any particular person. Each person's circumstances are unique and must be evaluated individually. Competent legal counsel should be sought before taking any action in reliance upon the information contained in this presentation. The contents of this presentation may not be reproduced, transmitted or distributed without the express written consent of Krieg DeVault LLP. Presented by: David E. Jose, Esq. One Indiana Square, Suite 2800 Indianapolis, IN 46204 Phone: (317) 238-6211 djose@kdlegal.com