Cave Consulting Group's (CCGroup) Midwest Health System Client Has Superior Performance Results for Knee/Hip Replacement Surgery
SAN MATEO, Calif.--(BUSINESS WIRE)--'Using our extensive benchmarking database, CCGroup identifies a Midwest health system client as being in the upper performance tier for treating lower extremity joint replacements (LEJR) under the CMS Transforming Episode Accountability Model (TEAM),' stated Dr. Douglas G. Cave, President/CEO of CCGroup.
'The CCGroup-CMS Region LEJR bundle average is $20,500, while our client's average is $17,000 (or 17% more efficient),' stated Yuri Alexandrian, COO of CCGroup.
He continued, 'Our health system client participated in the CMS Bundled Payments for Care Improvement (BPCI) initiative for knee/hip replacement. During this time, the health system implemented a new operating model where knee/hip replacement surgery moved from inpatient facility to outpatient facility and ambulatory surgery center (ASC) settings. Now, our client is mandated to participate in CMS TEAM bundles payment.'
CCGroup determines LEJR TEAM bundle results using the CCGroup-CMS Innovator Project. 'The CCGroup-CMS Innovator Project is a Cloud/SaaS Subscription Model offering that has efficiency and quality results for most practicing specialists in the United States,' explained Dr. Cave.
'The CCGroup-CMS Region LEJR bundle average is $20,500, while our client's average is $17,000 (or 17% more efficient),' stated Yuri Alexandrian, COO of CCGroup. A main reason for bundle efficiency improvement is the significant movement from inpatient to outpatient facility for our client's LEJR bundles. For instance, the CCGroup-CMS Region average is 55 admissions per 100 LEJR bundles as compared to our client's average of 23 admissions per 100 LEJR bundles. 'This finding decreases our client's average inpatient cost to $3,300 per bundle as compared to the peer group's average of $8,300 per bundle (or 60% less),' explained Mr. Alexandrian.
Dr. Cave mentioned, 'Inpatient facility reduction is only half the battle to achieving a high performance bundle rating. A health system also needs to reduce adverse events as measured by unplanned hospital readmissions and the CMS patient safety and adverse events (PSAE) composite. Our client's PSAE composite is 30% of all LEJR bundles, while the CCGroup-CMS Region PSAE composite is 19% (both are higher than expected). The key adverse event category is complications directly related to surgery. Our client understands the need to address ASC quality improvement.'
Moreover, during the 30-day follow-up period, health systems must address the appropriate post-acute care level of rehabilitation facility and home health care (Rehab/HHC) services. Mr. Alexandrian defined, 'In many instances, we observe savings achieved from lower LEJR inpatient facility utilization that is mostly offset by overutilization of Rehab/HHC services. However, this is not the case for our client where the average Rehab/HHC amount is $775 per bundle as compared to the peer group of $1,200 per bundle (or 35% less).' CCGroup benchmark results show average Rehab/HHC per LEJR bundle varies from $450 to $3,100 – over a 6-fold difference.
Future press releases will address CCGroup client-related results for CMS TEAM surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.
About Cave Consulting Group, Inc. (CCGroup)
Cave Consulting Group, Inc. is a software and consulting firm located in San Mateo, California. The company is focused on improving the efficiency (cost-of-care) and effectiveness (quality-of-care) of the healthcare delivery system. Senior management of CCGroup has assessed the performance of physicians and hospitals for over 33 years for health systems, provider groups, CINs, ACOs, health plans, HMOs, and TPAs.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Forbes
6 hours ago
- Forbes
5 Timely Ideas To Improve Medicare Advantage
WASHINGTON, DC - MARCH 14: Dr. Mehmet Oz, arrives for his confirmation hearing with the Senate ... More Finance Committee in the Dirksen Senate Office Building on March 14, 2025 in Washington, DC. Oz is U.S. President Donald Trump's nominee to be administrator of the Centers for Medicare and Medicaid Services. (Photo by) In April, Dr. Mehmet Oz became Administrator of the Centers for Medicare & Medicaid Services (CMS). While his appointment generated a buzz, it is the work ahead that truly matters, especially when it comes to Medicare Advantage (MA), the program that provides care to about 33 million people, or 54 percent of the Medicare population. Though MA is poised to provide the best outcomes for the most Americans, the program is also ripe for reform, and there are several critical areas Oz could focus on to drive meaningful improvement. Here are five: 1. Pilot Multiyear Enrollment in Plans. MA plans looking to make investments in prevention and effective treatment face a conundrum: people under our care drop out of our plans on an annual basis. One way to fix this is to move away from annual enrollment and create options for people to enroll in plans for several years at a time. Dr. Oz has called for 'shifting the paradigm for health care from a system that focuses on sick care to one that fosters prevention, wellness, and chronic disease management.' Multiyear enrollment would provide the necessary incentives to achieve this worthy goal because you can't really invest in improving health in 1-year increments. 2. Standardize Plan Benefits. Plans should be competing based on excellence and their proven abilities to drive outcomes, not edge benefits and giveaways like cash rebates. By adopting standardized plan benefits and requiring them to address genuine health needs, CMS could ensure that when consumers choose plans on the basis of plan quality and health outcomes—which should be the most important metric in their decision-making process. 3. Reform Broker Commissions. Lately, there's been a lot of talk about reforming the way MA brokers are compensated. Last year, CMS issued a rule capping broker compensation, but that rule was blocked by a judge before it took effect. And recently, the Department of Justice alleged in a lawsuit that insurers were paying kickbacks to brokers in return for steering beneficiaries toward their plans. Amid these developments, we too rarely discuss ways to encourage brokers to steer people toward higher-quality plans. It's time to align broker commissions with plan ratings. Under this approach, a broker who enrolls a client in a higher-rated plan would receive a larger commission than one who steers a client toward a lower-rated plan. CMS estimates that last year almost 38% of MA enrollment was in plans with fewer than four stars. We owe it to plan members to create a system that provides their brokers with every incentive to help them choose plans of the highest quality. 4. Reform the Broker Industry to Focus More on Clinical Support. While we'refocusing on brokers, let's also provide them with incentives to use their expertise more expansively to improve health. I've spoken to brokers who help clients find care and navigate medical bureaucracies, locate the best prices on medications, and even connect them with life-saving social services. Brokers earn renewal fees when their clients sign up annually for MA plans. Those renewal fees should be earned by annually providing clients with care navigation and other health services that drive positive clinical outcomes. Brokers who don't offer such services should receive reduced renewal fees—or maybe not continue to serve seniors at all. Either way, it's worth noting how many outstanding brokers already do this work and are among the most trusted members of their communities—exactly the kind of behaviors that should be rewarded. 5. Incentivize Integration Between Health Plans and Provider Organizations. There's a lot of friction in our healthcare system, especially between health plans and provider organizations. Plans allege providers drive up costs with unnecessary procedures, tests and prescription medications; providers say plans are inflexible and stand in the way of appropriate patient care. It's beyond time to change the dynamic between these two groups. Many have already discovered that the best way to do this is to enter into global capitation arrangements by which providers receive a fee to manage all of a plan member's healthcare expenses. The benefit of these arrangements is that they encourage each group to focus on what they do best: payers manage risk while providers make decisions about direct care. The best of these arrangements are true partnerships in which payers and providers transparently design products together that play to both groups' strengths with an orientation toward improving outcomes. Going forward, it would be in patients' interests for CMS to offer a standardized framework for payers and providers to collaborate in this way. The appointment of a new CMS Administrator presents a unique opportunity to enact substantial and lasting changes. That's certainly the case with Dr. Mehmet Oz. By focusing on these five key areas, he can help unleash the full potential of Medicare Advantage, benefiting older adults across the country.
Forbes
2 days ago
- Forbes
3 Mistakes To Avoid During Your Performance Review
3 Mistakes To Avoid During Your Performance Review When we think of performance reviews, we usually assume it's all the manager's job. We just wait for their judgment of our work. But performance reviews should be a collaborative process. You have the opportunity to review your progress, highlight your wins, and be open about your goals and even struggles. According to Gallup, however, only 20% of employees think their performance reviews motivate them to excel in their work. The good news? You can take control or at least play an active role for a more meaningful conversation with your boss. Here are some mistakes you can avoid during your performance review and leverage it to level up your career. Not Being Prepared Performance reviews are no ordinary events where you simply show up and listen. You should go there equipped with all the records you need to show your growth and achievements. Meeting your boss empty-handed means a missed opportunity for your career. So, before the review, have your brag sheet ready. List your wins, including those times you received commendations from big clients, exceeded the team's target, and mentored new members. Don't forget to record those moments you've stepped up and led projects, solved recurring problems, or introduced new tools that increased the team's efficiency. By putting everything into writing, you can easily address your manager's questions or clarifications with real numbers and specific scenarios. Speaking of questions, you should also prepare thoughtful responses. Anticipate being asked about your areas for improvement, action plans, and goals for the next quarter or year. Your manager might also ask you about skills you want to develop, your experience with the team, and how else you can support each other. By reflecting on these questions, you can express your insights well. Prepare your own questions as well to gain more valuable input from your manager. Not Selling Yourself Being ready with your records is one thing; selling yourself is another. The latter is crucial, especially if you're eyeing a promotion or a raise. But even when you're not, you should still know how to advocate for yourself confidently and professionally. This can lead to more opportunities, like flexible schedules, better projects, and greater confidence from your boss. So highlight your contributions to the team and how they made a difference. For example, you can say, 'I'm grateful to have helped increase the team's sales by 30% through personalized welcome and milestone packages, which made new and existing customers feel valued.' Mention the kudos you received from colleagues, bosses, or clients. For instance, 'I'm honored to be praised by such a meticulous client who even committed to giving us more projects.' More than the flex, you're showing the value you bring to the team and how you can't be easily replaced. Not Even Having One Ideally, your manager should give you regular performance reviews. But this may not always be the case. In fact, 47% of employees get feedback only a few times a year or even less. A Gallup survey also showed that 95% of managers aren't happy with their performance review systems. If the company you're in doesn't have an organized review system, or worse, doesn't do performance reviews at all, be proactive. Politely ask for a meeting with your manager, so you can talk about your progress, challenges, goals, and timelines. For example, you can say, 'I'm wondering if we could have a quick feedback session next week to make sure I'm aligned with the team's goals and expectations.' It's not about being demanding but rather taking the initiative to stay on track with your responsibilities and long-term growth. Even without regular reviews, make sure to record informal feedback you've received along the way so you have something to start with. Performance reviews may sometimes feel more discouraging than inspiring, but you can use them to your advantage with the right approach. Do not make the mistake of coming unprepared, not knowing how to sell yourself, or simply accepting the absence of a review. These evaluations are not threats but opportunities, so welcome them!
Politico
2 days ago
- Politico
RFK Jr. goes after immigrants to cut health insurance costs
The Trump administration is tightening eligibility for Obamacare coverage in what it says is a bid to combat a 'surge of improper enrollments' and to lower insurance costs broadly. Critics say the rule changes will cause eligible people to miss out on a chance at subsidized health insurance and increase the uninsured rate. 'With this rule, we're lowering marketplace premiums, expanding coverage for families, and ensuring that illegal aliens do not receive taxpayer-funded health insurance,' HHS Secretary Robert F. Kennedy Jr. said in a press release that projects $12 billion in savings from the rule changes next year. Those changes include reducing the enrollment period for plans by two weeks, adding paperwork requirements for some enrollees, ending the use of federal subsidies to help cover the cost of transgender people's transition-related medical care, and barring Deferred Action for Childhood Arrivals recipients from purchasing insurance on the exchanges. Those are immigrants brought to the country without documentation when they were children whom President Barack Obama protected from deportation. The final rule also repeals a special enrollment period for individuals in households earning less than 150 percent of the federal poverty level. CMS estimates about 725,000 to 1.8 million people will lose coverage as a result of the final rule. In January, CMS said about 24 million people had signed up for Obamacare coverage for 2025. Many of those will lose coverage because enrollment will be less consumer-friendly, said Larry Levitt, who advised President Bill Clinton on health policy and is now executive vice president for health policy at KFF, a health care think tank. 'I think the combination of the shorter open enrollment period and the more complex income verification rules will result in more people falling through the cracks,' Levitt said. Levitt noted that many policies in the final rule are effective only for the 2026 plan year, but that could change if Congress codifies them. The House last month included some of the changes in its version of President Donald Trump's megabill. The Senate hasn't yet voted on its version of the bill, which aims to extend Trump's 2017 tax cuts but needs budget savings to do it. The final rule shortens the annual open enrollment period from Nov. 1 to Dec. 31. The previous enrollment period ran from Nov. 1 to Jan. 15. The regulation also eliminates a policy under which individuals with low incomes who are eligible for premium-free plans are automatically re-enrolled in them. Under the new rule, they will be re-enrolled with a $5 monthly premium in plan year 2026. If the individual files paperwork showing they are still eligible for a no-premium plan, they'll be re-enrolled in one. Taken together, CMS estimates the changes will cause individual health insurance premiums to drop by an average of 5 percent.
