Standard practices produce better results, says Ken Steele, principal with ECG Management Consultants.

With bundled payments and other quality initiatives, hospitals should constantly improve their processes, Steele says. “When the variations are removed from the system, it increases the quality of care across the board,” he says.

He recommends that a multidisciplinary team from the hospital work with community physicians and post-acute providers to develop protocols. One of the main focuses of the committees should be reducing variation by developing an evidence-based process to follow with each bundle, he adds.

For instance, standard processes allow case managers and nursing to inform patients and family members up front about what is going to happen, he says.

The entire clinical team should be involved in designing protocols, says Teresa Marshall, RN, MS, CCM, senior managing consultant for Berkeley Research Group.

“Anyone involved within the 90-day period covered by the bundled payment contract should be involved in the process. If everyone who will be involved with patients participates in the development of the plan, they’re more likely to buy into it,” she adds.

The stakeholders on the oversight committees should work together to develop protocols that are based on best practices and standardize care provided by all disciplines across the continuum, says John Wagner, associate director at Berkeley Research Group.

Wagner suggests ending the variation in supplies and apparatuses as well, a move that will reduce costs and create consistency. “If hospitals take the variability out of the system, they generally end up with lower costs, improved quality, and consistent clinical outcomes,” he says.

Create a dashboard, hand out report cards to all clinicians, and review data to identify opportunities, Marshall says.

After the program begins, committees specific to each category of diagnoses the hospital has chosen should monitor progress, track quality and outcomes, and make improvements with the goal of reducing costs and improving quality of care, Steele recommends.

“The goal is to lower the length of stay and cost of care while maintaining good outcomes. The analysis and changes should be in real time,” he says.

For instance, when patients are readmitted, the committees should immediately analyze the stay and the discharge plan to determine the cause and how the readmission could have been avoided.

As part of the bundled payment initiative, case managers should make sure every clinician is adhering to the clinical path. Track and trend physician practices and work with your physician advisor to educate the outliers, he adds.

Once the care processes are in place and physicians are complying with the order sets, case managers should make sure all physicians are documenting correctly and ordering services that are appropriate for an inpatient stay, says Brian Pisarsky, RN, MHA, ACM, director at KPMG Healthcare Solutions.

“Case managers should discuss variations with the individual physician as well as with the department’s physician advisor. There may be a good reason for the variation,” Pisarsky says.