Episode-Based Care Payment Approach: Using Advanced Imaging Technologies to Diagnose Acute Stroke More Effectively
Over the next several years, healthcare economic policies will change the delivery of medicine. The healthcare sector will migrate from a fragmented, volume-based system to one that is driven by value, accountability, quality and outcomes. As the new episode-based payment programs come into play, it will be incumbent upon stakeholders to demonstrate the clinical utility, operational efficiency and financial performance of new technologies.
Toshiba America Medical Systems, Inc.’s imaging technology offers solutions that will assist healthcare institutions in preparing for episode-based care by effectively utilizing patient-focused imaging technology and a multidisciplinary collaborative approach to treatment.
Episode-Based Care Payment Model
Episode-based care is a payment approach that reimburses providers on expected costs for clinically defined episodes, rather than on a fee-for-service basis. Episode of care provides one fixed payment for the treatment of a specific illness and combines the technical fee with the professional fee. Since this payment approach provides reimbursement on expected costs for clinically defined episodes rather than fee-for-service, healthcare providers must achieve greater efficiencies and better patient outcomes. For example, if a patient has a stroke, everything done to diagnose and treat that condition is bundled together into one clinically defined episode. The goal is to reduce unnecessary services, duplicity of tests and complications – while compensating clinicians for improving the quality of care and reducing costs.
Medicare will launch the episode-based care pilot program no later than January 1, 2013. With such a large segment of patients with this coverage, it will require healthcare organizations to be even more efficient in how they deliver care.
Diagnosing Acute Stroke in an Episode-Based Care Model
Stroke accounts for approximately one in every 18 deaths and is the third most common cause of death in the U.S., according to the American Heart Association. The estimated annual cost of stroke is $50 billion, including healthcare-related costs, disability and lost productivity. When the new episode-based program comes into effect, clinicians will be tasked to diagnose and treat stroke more accurately and quickly to benefit the patient and reduce costs. When evaluating medical conditions to include in this new payment model, Medicare will look at high-cost, high-volume, chronic and acute conditions like stroke, when vetting case types for the pilot program.
In today’s top hospitals and stroke centers, clinicians use the latest CT technology to perform cerebral perfusion imaging to assess neurological disorders, such as stroke, and to make treatment decisions. Depending on the specific case, patients are often taken to interventional labs where the imaging equipment helps guide treatment and supports device placement.
This was not always the case, as limitations in the coverage volume of CT previously prevented perfusion imaging from being a truly effective tool in diagnosing stroke. However, developments in imaging technology, particularly CT, are enabling healthcare professionals to diagnose and treat stroke faster than ever before.
Diagnosing Stroke with Toshiba’s Aquilion ONE
The introduction of Toshiba’s Aquilion TM ONE dynamic volume CT system changed the scope of cerebral perfusion analysis by enabling dynamic imaging of the entire brain and the ability to reduce diagnosis time from hours to minutes. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra-high resolution 0.5 mm detector elements to image an entire organ, including the brain, in a single rotation. It can show the brain’s dynamic blood flow and real-time function, which is crucial for stroke patients and enables rapid and accurate diagnosis when time is critical.
The Aquilion ONE also features a full suite of dose reduction technologies that limit radiation dose to the lowest possible amounts while maintaining the highest clinically-appropriate image quality needed for diagnosis.
Kaleida Health Stroke Center at Millard Fillmore Gates Circle Hospital and Its Use of Toshiba’s Imaging Technology
Toshiba understands that effectively transitioning to episode-based care requires more than just superior imaging equipment; it requires the cooperation and collaboration of a multidisciplinary team of physicians that appropriately leverage the technology to its fullest capabilities to the benefit of the patient. Toshiba’s technology offers solutions to help healthcare facilities prepare for episode-based care by effectively utilizing patient-focused imaging technology and a multidisciplinary collaborative approach to treatment. Toshiba uniquely offers a multidimensional knowledge base, dynamic customer interaction, and a robust support system of training and education to help medical teams transition and prosper within the new healthcare economic models.
One such example is Toshiba’s partnership with the Kaleida Health Stroke Center at Millard Fillmore Gates Circle Hospital in Buffalo, N.Y. Millard Fillmore Hospital is a 189-bed facility that is part of Kaleida Health, the largest, most comprehensive healthcare system in the region. It is a modern acute care center offering a full range of medical and surgical services, including a world-class neurological and stroke care. The Kaleida Health Stroke Center has integrated Toshiba’s state-of-the-art training and imaging with an outstanding multidisciplinary team of physicians, nurses and technicians, comprehensive education and community outreach. The result has been an improvement in both patient and financial outcomes in the diagnosis of acute stroke that demonstrates a commitment to delivering quality care to the community.
Millard Fillmore’s Results Using 320-Detector Row CT in Diagnosing Acute Stroke
To quantify the results of utilizing the Aquilion ONE in the diagnosis and treatment of acute stroke, Toshiba and Millard Fillmore conducted a retrospective and prospective study on its effectiveness in treating these patients with the new technology. The goal of the non-controlled study was to measure the economic impact that 320-detector row CT has had on the diagnostic workup of patients presenting with symptoms of acute stroke and transient ischemic attack (TIA). Millard Fillmore reviewed the patient diagnostic workup on a retrospective and prospective basis and analyzed all the imaging procedures utilized during the acute inpatient episode of care, focusing on the changes in the diagnostic work-up, inpatient length of stay and discharging disposition since acquiring the Aquilion ONE. Inpatient data sets prior to the Aquilion ONE installation were compared with data sets using the Aquilion ONE, and concerned the top three discharging ICD-9-CM stroke codes.
When Millard Fillmore analyzed the length of stay, discharge disposition and healthcare costs for the top three ICD-9-CM codes for stroke and compared the 2007 and 2009 data sets, the results demonstrated the benefits 320-detector row technology brought to the facility and its patient community. For the three stroke ICD-9-CM codes analyzed, Millard Fillmore found a reduction in hospital stay, had more patients discharged to home and achieved an approximate annualized savings of more than $750,000.
The Kaleida Health Stroke Center at Millard Fillmore is an impressive example of how an exceptional multidisciplinary team with comprehensive education and community outreach can use innovative imaging technology to make a difference in the lives of patients, improve financial performance and result in high quality patient care in today’s uncertain times. Healthcare facilities everywhere can experience the significant cost savings achieved through reduced length of stay, reduction in outpatient services, reduced complications, and lower recurrence of readmission.
The reality is that hospitals that choose not to participate in the national pilot program will be at risk of losing market share because Medicare patients will be encouraged to utilize participating facilities. The healthcare providers which embrace this new, value-based collaborative approach to providing high-quality care can not only retain but even increase market penetration. Toshiba has a proactive approach with the knowledge base, customer support and technology to help healthcare organizations successfully transition and succeed.
Tags: CT, Episode Based Care, Medical Imaging
Category: Future Technology,Medical Equipment,Medical Imaging —