Tuesday, 27 October 2015 22:43

LTPAC Providers to Play Key Role as VBP Takes Hold

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This is the first in a series of VBPmonitor articles on the long-term, post-acute care (LTPAC) healthcare segment. LTPAC is the third major healthcare segment in the spectrum of healthcare providers, with the other two being acute care (hospitals) and ambulatory care (physicians).

In order to understand the role of LTPAC providers in the evolving spectrum of care, one must understand the providers of care that make up LTPAC. This can most easily be illustrated by the following graphic:

In 2004, President Bush signed an executive order to digitize healthcare and formed the sub-cabinet-level position of the Office of the National Coordinator for Health Information Technology (ONC). At the time there was no budget to form a ONC division of the U.S. Department of Health and Human Services (HHS) to develop the program. In 2005, the LTPAC HIT Collaborative was formed to coordinate all of the LTPAC associations in matters that concerned clinical technology. The Collaborative is the only group that has a LTPAC HIT focus, and it has held an annual LTPAC HIT summit since 2005 and published many roadmaps that are in harmony with the ONC roadmaps.

It was not until the 2009 ARRA HITECH Act was passed and the program financed and defined that the ONC Department gained financing and structure. The HITECH Act established an incentive program based on standards to establish the electronic health record (EHR). It defined the two eligible providers (EPs) that would receive financial incentives to update their health IT systems in order to meet the criteria of meaningful use (MU). These two EPs were hospitals and physicians. The legislation left out two important primary care providers: LTPAC and behavioral health (BH). Behavioral health crosses all care providers but has its own health IT requirements.

It was illogical that LTPAC was omitted from the HITECH Act, as 40-60 percent of those discharged from hospitals go to nursing centers (SNFs) or home health agencies (HHAs) for post-acute care to prevent re-hospitalization. The following graphic illustrates to where patients are discharged from a hospital episodic event:

In the years since the passage of the HITECH Act it has become obvious that LTPAC providers and software vendors play an important role in achieving the ultimate goal of person-centric, electronic longitudinal care with a focus on prevention and wellness. In today’s provider partnership care coordination payment models, it is important that all providers of care understand their roles as well as the roles and responsibilities of their care partners in person-centered coordinated care.

ONC has supported the inclusion of LTPAC providers in many effective grant programs even though there were not incentive monies to assist LTPAC providers to upgrade their health IT systems. The LTPAC sector did not just fold its arms and refuse to participate, however. The providers and support services understood that they were very valuable partners in longitudinal care and had a great deal to offer the new healthcare system in achieving the objectives of the HITECH. In spite of being left out of the HITECH Act, the LTPAC community has continued to prepare for inclusion even though their Medicare and Medicaid reimbursements have not provided the funds to upgrade their health IT infrastructure; both the provider and software vendors have moved forward because interoperability and care coordination speaks to a higher level of quality of care and quality of life. Besides, the LTPAC provider has been providing longitudinal care for years, as these providers have patients under their care in a controlled environment of healthcare professionals for a longer period of time than any other provider. This does not include the Medicare/Medicaid dual-eligible residents living in SNFs, as they do not have any other place to live.

This article and future articles in this series pertain to the short-term care patients who are under care for post-operative rehabilitation, chronic disease management, and other complex conditions that require a short period of time in a controlled healthcare professional environment before moving to the home of the person’s choice. The typical length of stay in a nursing center is from 10-15 days.

In May 2015, the ONC asked the LTPAC HIT Collaborative to produce a brief on the LTPAC Value Proposition and Valued Quality Care Coordination (VQCC) differentials between all provider healthcare sectors. In the ONC brief there were five major VQCC differentials that were identified. It is these that will form the basis for the subsequent articles in this series.

About the Author

John F. Derr, RPh, is CEO of JD & Associates Enterprises, specializing in strategic clinical technology with a focus on person-centric electronic longitudinal medication management and LTPAC. He has over 50 years of top executive-level experience with Squibb, Siemens, Tenet (NME), Kyocera, MediSpan, and EVP of AHCA. He was SVP, CIO, and CTO for Golden Living, LLC. He is a member of corporate boards providing guidance on clinical health IT and medication management. He represents LTPAC and pharmacy as a member of HHS HITECH Committee on Standards. Derr is a graduate of Purdue School of Pharmacy and a 2006 Distinguished Purdue Alumnus.

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John F. Derr, RPh is CEO of JD & Associates Enterprises specializing in Strategic Clinical Technology with a focus on person centric electronic longitudinal medication management and LTPAC. He has over fifty years of top executive level experience Squibb, Siemens, Tenet (NME), Kyocera, MediSpan and EVP of AHCA. He was SVP, CIO and CTO for Golden Living, LLC. He is a member of Corporate Boards providing guidance on clinical Health IT and medication management. He represents LTPAC and Pharmacy as a member of HHS HITECH Committee on Standards. Derr is a graduate of Purdue School of Pharmacy and a 2006 Distinguished Purdue Alumnus.