Healthcare Financial Management Association

Following the Centers for Medicare and Medicaid Services' approval of the Acute Hospital Care at Home waiver, an increasing number of health care organizations launched Home Hospital (HH) programs in the USA. Ongoing barriers include access to HH expertise and a standard, comprehensive set of implementation tools. We created the HH Early Adopters Accelerator to bring together a network of health care organizations to develop tools ("knowledge products") necessary for HH implementation. To demonstrate the feasibility of the Accelerator approach for generating and implementing relevant, high-quality knowledge products. Mixed methods evaluation of the Accelerator. Surveys and qualitative interviews of Accelerator participants were conducted. Surveys elicited feedback on the knowledge products, including time spent on development, perceived utility and quality, and implementation success. The qualitative interviews gathered more in-depth information on topics covered in the surveys. Eighteen healthcare organizations and 105 individuals participated in the Accelerator. The Accelerator reached its goal and developed 20 knowledge products in 32 working weeks (more efficient than expected). Participants agreed that the knowledge products were useful (developers: 98.1%; stakeholders: 93.8%), of high quality (developers: 96.8%), and would improve patient care if implemented in their HH program (developers: 91.7%; stakeholders: 91.2%). Two thirds (66.7%) of the participating organizations who had implemented knowledge products at 3 months continued utilizing knowledge products in their HH program at 1 year. Agreement that knowledge products improve patient care persisted (92% strongly agreed or agreed) at 1 year. Several programs created new tools, policies, and workflows as a result of implementing the knowledge products. The Accelerator created high-quality, comprehensive knowledge products that healthcare organizations found useful for safe HH implementation 1 year later. The Accelerator approach can feasibly help healthcare organizations safely bridge the gap between innovation and standard practice.

As healthcare nears year three of the COVID-19 pandemic, hospitals and health systems should consider accepting significant responsibility for the total cost of care from all sources, per covered life, over time. One place to start: Reduce avoidable spending on chronic conditions, which, combined with mental health conditions, account for most healthcare expenditures. This shift will necessitate investments that strengthen the ability to identify at-risk populations and react in ways that help avoid complications and reduce unnecessary costs.Even before the pandemic, it was clear that there were missed opportunities to reduce costs of care. Failures in care coordination contributed to billions of dollars in waste each year. Now, as payers explore innovative risk-based arrangements for addressing the impacts of social determinants of health and delayed care on health outcomes, healthcare providers should seek opportunities to partner with payers in developing shared-risk approaches to patient engagement and chronic condition management. Steps toward designing a model for risk innovation include rewarding physicians and clinicians for managing the total cost of care, involving physicians in discussions around acceptable levels of risk in value-based contracts, ensuring that the organization's cost accounting approach meets its strategic needs, investing in actuaries to study data that can identify rising-risk patients, and exploring innovative partnerships for funding the infrastructure for value.

Complex regional pain syndrome (CRPS) type 1 is a disorder of the extremities characterized by pain, edema, limited range of motion, integument changes, and vasomotor instability often after an inciting event. In the pediatric population, CRPS may be misdiagnosed, or missed entirely, as CRPS literature for this patient population is lacking. Twenty-seven pediatric patient medical records with the diagnosis of CRPS type 1 from the institutional and private practices of the principal investigator (E.J.H.) were reviewed for demographics, inciting event, lower-extremity clinical examination, ancillary testing, previous treatments, time to diagnosis, treatment after diagnosis, and time to resolution of symptoms. Females composed 85.2% of the patient population (n = 23) (mean age of females, 11.11 years). An inciting event preceded pain in 74.1% of patients (n = 20). On physical examination, more than 50% of patients were identified as having changes in skin color and temperature, edema to the affected lower extremity, painful or decreased range of motion in affected joints, and intact lower-extremity motor function. The average time to resolution of symptoms was 6.8 weeks for the entire population. Diagnosis of CRPS type 1 should be considered in a preadolescent female complaining of pain out of proportion after an inciting event with a physical examination demonstrating change in skin color, decrease in skin temperature, edema, and painful or diminished range of motion in affected joints. Prompt diagnosis can decrease the time to resolution of symptoms.