#LeadingVBHC – We talked to Kelly Price, Vice President and Chief of Healthcare Data Analytics at DataGen after her presentation, Fundamentals of the CJR Rule & Coming Bundles. Watch our very own Bre Cunningham gets Price to share the secrets to her success when it comes to bundled payments.


Transcription below:

Breanna Cunningham: Hi there, Bre Cunningham. I’m here with Kelly Price, who you were probably able to watch during the live stream. Kelly is one of the amazing and unique people who loved bundled payments and all things related to payments.

In her day-to-day world, she goes around the country educating hospitals, educating states on the nuance and the rules of the game, as you put it. Gosh, there’s so many facts that we could talk about this very complicated subject. Where I’d like to take-off is on the education policies. When you go into a hospital, and you do the education process, where do you see success, and where do you see the barriers to getting your program up and running?

Kelly Price: Where we see success, is when the hospital recognizes that this isn’t just a small program they can drop in the hands of their finance department or their managed care contracting department and let them take over. A lot of hospitals, they’re dealing with really small volumes, or just don’t even know where to start, will do something like that. That won’t succeed. You can’t just assign it to one area of the hospital. This is payment reform that requires teams of people from all over the organization, you need those managed care contracting people, you need the strategic folks, you need quality, you need the physicians, you need the finance and the leadership support, the discharge planners, to bring together a team with enough of the right people in it to be disruptive and it’s a pretty big effort.

The ones that we see that are successful, that recognize that ahead of time, will start from that point of view. Other ones maybe start small, but we do see them, over time, recognizing that [inaudible 00:01:51] kind of a program, to be successful in it, and at least not to lose money in it, does require them to add focus to those kinds of teams. We will find ourselves just continually educating new people. They’ll get one concept down and they’ll solve one problem. Then, what happens? They move on to the next strategy, so we’ll start educating them about the interaction of that strategy with the rules of policy. It’s just a continuing thing.

It’s been fascinating to me that the base level of education that we provide just continues to be needed over and over and over again. Because you’ve now got people who really never had to concern themselves with what are medicare’s payment rules. Now, they don’t necessarily need to understand it, but for them to absorb the either success or failure of some sort of strategy that they’ve put into place, it helps them to have this added context. They can say, “Okay, this was the right thing to do for the patient. Maybe it’s not working out in the interaction with the rules. Can we modify it enough that it works with the rules and not get rid of the benefit patient.”

Cunningham: Sure. You’re right. I mentioned earlier that this conference is sold out and maxed out. There was more of an audience than anticipated. It makes sense, because a lot of conferences are very clinically focused or financed focused. There just hasn’t really been a need, until now, to look and see what’s happening with the education. I anticipate that this is going to be curriculum or part of many courses coming up in the future, education is definitely needed. Do you think that people will be opting out of these programs, or do you think that now that it’s mandated through medicare that more people are just going to start complying, start learning, start getting involved?

Price: I think the ones that are mandated, most of them, are definitely making an effort. There are a few hospitals out there, who are mandated, who are still so volume that the resources required to go along with the program, to comply, not to comply, to succeed in the program, are still just beyond the numbers of cases that we have. That’s one of the things that we have to convince CMS that there still needs to be-

Cunningham: Is there a threshold? Can you throw out a number for THE CJR program?

Price: They’re consistent for a no. What we consider a good threshold is at least 100 cases a year in that particular area. But we certainly see hospitals, who are under mandate, and I would say have maybe 20 cases a year. That’s a very low revenue stream to try to put together something so massive.

Cunningham: Absolutely. Absolutely.

Price: We definitely see folks getting more and more interested. They do see this as something that’s coming at them. Over the last two years especially, both hospitals, whether they’re in a mandatory MSA or not, and the post-acute providers, they’ve heard it enough times now, they’re starting to understand the concepts and can be able to really absorb it now. I think, at first, it was just too overwhelming. There’s so many [inaudible 00:05:09] providers out there right now. They’re medicaid issues, reporting issues, there’s all this technology. This is not always as up front, in terms of the things that they truly need to tackle right now. Literally, you can put it on the back burner and it’s still just going on. You may find yourself owing money back, afterward, but it is something that compared to some of these other programs, where you absolutely need to act, this can be put on the back burner. Folks are getting more comfortable. Folks are getting more comfortable and starting to understand the concepts and pay attention and feel a little less overwhelmed.

Cunningham: I was just about to say, it’s like that bill that you don’t want to open, right? I’ll deal with it someday. So education, it’s a huge barrier and it’s so much information. You come to conferences like this and get a big bowl of stuff, how much of it do you really retain? Do you have a suggestion where people could go to get titrated information that would help them passively stay up to date, or passively stay active in what’s going on, how to be prepared new world of bundles?

Price: A lot of providers do get drips of information, not drips but periodic information, out of their state associations and other types of providers will get this kind of information out of their state associations. It’s going to be at a higher level, they can start to absorb things a little bit at a time. But in terms of folks who are already in a mandated program, I agree with you, come out of a conference like this completely overwhelmed, with a list of 45 things you need to do tomorrow.

I think the most important thing, and I think someone showed a picture of the elephant book, is that “How do you eat an elephant? One bite at a time.” If you come away from conferences like this with at least a list of folks that you know, when you’re ready to tackle it, you can reach out to them. Focus on the thing you think your organization can absorb today, and you’ll get to those other things, because you cannot do it all at once.

It’s trying to figure out how to stay … How to keep focused on what you can act on, because you can’t act on everything. I think you’ll see in some of the presentations this afternoon, Jon Pearce in particular, he talks very much about looking at the data, looking at the things that are required for me to do, and decide what’s the area I think I can act on now. What do I think I can have an impact on versus what do I think I can’t have an impact on. Pick the thing you think you can have an impact on, start down that road, and at least you’ve got some success. You begin to get the team engaged. Keeping the frustration and overwhelm out of the team is really important, and then just adding in the other things a little bit at a time. You can’t do it all at once.

Cunningham: I love that concept of success breading success. This has been fantastic. Thank you so much for elaborating on your great talk and look forward to keeping posted on what’s going on with CMS and all things bundled.


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Ellen Laux

Ellen Laux

Ellen is a design and marketing veteran and lives on the marketing team at CODE. She's focusing on helping surgeons and hospitals understand and LOVE PROs.

ellen@codetechnology.com