This article is more than 5 years old. Information may no longer be current.
Panelists outline important steps in successful ESCO management
Click Here to Manage Email Alerts
ORLANDO, Fla. — Organization has proven an important component in the successful launch of End-Stage Renal Disease Seamless Care Organizations in Louisiana, Tennessee, and South and North Carolina, a panel of physician practice managers said at the Renal Physicians Association Annual Meeting here. However, they noted that sometimes, risk-taking is unavoidable to keep the ESCO operations moving forward.
The group presented details about the workload involved for managing and helping to direct patient care, including how to meet quality measure goals; how to work with outside care teams and share and review patient outcomes; how to track hospital discharge information and patients; and how keep ahead of expenditures for the ESCOs, which are the core model for the Comprehensive ESRD Care Demonstration launched by CMS in 2015.
The panel included Mary Alice Stanford, MBA, CMPE, executive director of the Renal Associates of Baton Rouge LLC; David Arrieta, MBA, CMPE, of Nephrology Associates in Nashville, Tenn.; Jennifer Huneycutt, CPA, CMPE, executive director for Metrolina Nephrology Associates in Charlotte, NC; and Carole Ann Norman from Columbia Nephrology Associates PA in Columbia, SC.
For a smooth running ESCO, billing and administration is an important source of information, the panelists said.
“It is a conduit of information on patient status and the financial health of the ESCO,” Stanford said. “We estimate that we spend 30-40 hours a month in administration and billing.”
Likewise, the nephrologist serves a key role in patient care in the CEC model.
“Clearly, the nephrologist is the common denominator in the ESCO,” Stanford said. “They know how the hospital works, they are intimately aware of how the dialysis clinic works and often times the vascular access center. They are in the best position to drive results and set expectations for the ESCOs.”
One of the challenges, the panel agreed, is making decisions on patient care before the ESCOs financial status is current. That makes it difficult to tie interventions to financial outcomes. Fiscal year 2016 disbursements for the ESCOs, for example, were not received from CMS until November 2017.
The group noted the best way to measure success for the ESCOs might be outside the demonstration itself, ie, using the physician practice’s electronic medical record to help track medical procedures and patient health status. Strong relationships between dialysis center management and staff are also important, as have been relationships with hospital managers and hospitalists as the ESCOs look at ways to reduce hospitalizations and readmissions.
Key components in day-to-day operations of the ESCOs included:
Know who the ESCO-enrolled patients are and communicate that information to your physicians and medical extenders. “We have staff that monitors the ESCO patient roster,” Norman said. “It’s important that you identify the patients in your practice management system. You have to be able to track the care coordination codes.” Expect to increase your legal support because of the agreements between the ESCOs and other medical specialty partners, she added.
Coordinate post-hospital transitions with the physician practice and the dialysis center, which is similar to relationships seen in the early days of dialysis care, Arrieta said. “The ESCOs have forced us to look at delivering dialysis care the way it was years ago,” he said.
Streamline vascular access referrals and “be sure that medication reconciliations are being performed,” he said. “Ensure that missed treatments are reviewed daily and even minor infections are reported.”
Likewise, preventive steps can be taken to reduce hospitalizations, Arrieta said. “We can lower hospitalizations by taking care of primary care issues within the dialysis units, but that requires conversations with referring providers.” Nephrologists also need to closely coordinate care within the hospital. “Create mechanisms, working with dialysis companies, to quickly identify when ESCO patients are admitted,” he said. – by Mark E. Neumann
Reference:
Stanford MA, et al. Business Management Track: ESCO Management. Presented at: Renal Physicians Association Annual Meeting; March 15-18, 2018; Orlando, Fla.
Disclosures : The panelists report no relevant financial disclosures.