Latest news with #TransformingEpisodeAccountabilityModel
Newsweek
13-05-2025
- Health
- Newsweek
One of Hospitals' Most Profitable Procedures Has a Hidden Cost
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. Cardiac surgery is a lifeline for both patients and hospitals. It's one of the most profitable service lines in American medicine, generating an average of nearly $3.7 million in revenue per cardiovascular surgeon each year. But lurking beneath those earnings is a costly complication that's becoming harder for hospitals to ignore: acute kidney injury (AKI). AKI doesn't get as much attention as other postoperative risks, like stroke or infection—but it is startlingly common. Up to 80 percent of cardiac surgery patients may have some degree of AKI associated with the procedure, according to a 2023 study published in The Annals of Thoracic Surgery. For hospitals, that translates into longer ICU stays, higher readmission rates and up to $69,000 in additional costs per patient. In total, AKI adds $5.4 to $24 billion in complication costs to the U.S. health care system each year, researchers estimate. It's a stark irony, surgeons told Newsweek. The same procedures that keep hospital finances afloat are quietly draining resources through under-recognized complications. Researchers estimate that acute kidney injury (AKI) adds $5.4 to $24 billion in complication costs to the U.S. health care system each year. Researchers estimate that acute kidney injury (AKI) adds $5.4 to $24 billion in complication costs to the U.S. health care system each year. Photo-illustration by Newsweek/Getty "At most hospitals, one of the patients every day that you're operating on is going to have some degree of AKI," said Dr. Daniel Engelman, a cardiac surgeon and the medical director of the heart, vascular and critical care units at Baystate Medical Center in Springfield, Massachusetts. "What an unbelievable opportunity to improve patients' lives and save money." The issue has gained more visibility in recent years, Engelman said. But it still isn't a national priority—and the stakes are rising. AKI is on a collision course with new federal reimbursement policies that could put hospitals' already-strained margins at even greater risk. Under the Centers for Medicare and Medicaid Services' (CMS) upcoming Transforming Episode Accountability Model (TEAM)—effective January 1, 2026—hospitals will be held financially accountable for postsurgical outcomes, including Stage 2 or greater AKI. Engelman predicts that once hospital finance teams see how much they're being penalized for AKI, they'll be incentivized to minimize the "crazy number." "I think that's when things will change," he said, and "hospitals will realize that this is not acceptable." Why is AKI a blind spot in the first place? It isn't easy to change course on cardiac-surgery-associated AKI. Chronic kidney disease—a vulnerability that can heighten a patient's risk for developing AKI—is common in the senior population that is frequently referred for cardiac surgery. But the condition can be painless, Engelman said, "Patients don't know that they're walking around with only half their kidney function. And even if they do, it doesn't cause any disruption to their life until they [encounter] stress." That "stress" could be something unexpected, like dehydration on a beach day, or something planned, like cardiac surgery. Either way, the problem can escalate quickly. "Suddenly, we've taken someone who has 50 percent kidney function down to 10 percent kidney function," he said, "and we're in big, big trouble." It doesn't help that the current standard for AKI diagnosis is a blood test that detects a rise in serum creatinine levels. Creatinine is a waste product that is removed by the kidneys, so when kidney function drops, creatinine levels go up. But this is a "lagging indicator" of kidney function, Dr. Kevin Lobdell, director of regional cardiovascular and thoracic quality, education and research for Atrium Health, told Newsweek: serum creatinine levels may not rise until 48 to 72 hours after the onset of AKI. Urine output, on the other hand, is a leading indicator that can detect Stage 1 AKI about 11 hours earlier than blood tests. But manually tracking urine output is labor-intensive and error-prone, requiring bedside nurses to record data every hour. Both Engelman and Lobdell have seen it fall through the cracks in busy intensive care units (ICUs). "We need to pay better attention to urine output, because the kidney is very smart, and when you see a tiny decrease in urine output, it's telling you something is wrong," Engelman said. "But you won't know the patient's in trouble until you watch that urine output hour by hour, very, very closely." Is there any technology that can improve AKI detection? Heart function can be tracked in real time with an electrocardiogram. Lung problems can be reflected in seconds with a pulse oximeter. But since urine is the kidney's best biomarker, its function is much harder to track. Urine output is traditionally tracked with a Foley catheter—a device that hasn't changed much since it was introduced in 1929, experts told Newsweek. Catheters are common: at U.S. hospitals, one in five hospitalized patients have one at any given time. But they can also be also risky. In ICUs, 95 percent of urinary tract infections are associated with catheters, according to the International Society for Infectious Diseases. As hospital leaders double down on quality outcomes—and reduce pressures on their nursing staff—they may be wary of increasing catheter placements. "It is possible to work with the clinical team and nurses to closely monitor the hourly urine outputs, but in a busy unit with demanding patients, that can easily be overlooked," Lobdell said. "Any catheter system that can facilitate the automation of the [urine] drainage as well as accounting of the hourly urine output—giving us reliable information and decreasing the demands on the staff to both be aware of and treat those threats—is incredibly valuable." Hospitals and electronic medical record (EMR) vendors have been working to develop better interfaces, which could continually pull data from a catheter and graph trend lines. One company working to improve this process is Accuryn Medical. Their "smart" Foley catheter sweeps and "milks" its own line to unblock obstructions, calculates the patient's urine output and sends that information directly to the EMR. "This takes the manual work of milking the Foley or measuring urine completely off the nurse's plate," Todd Dunn, CEO of Accuryn Medical, told Newsweek. This diagram shows the placement and function of a Foley urinary catheter. A flexible tube is inserted into the bladder through the urethra to continuously drain urine. Once in place, a small balloon near the... This diagram shows the placement and function of a Foley urinary catheter. A flexible tube is inserted into the bladder through the urethra to continuously drain urine. Once in place, a small balloon near the tip is inflated with sterile water to keep the catheter securely positioned in the bladder. Urine is collected in a bag outside the body, where medical teams can monitor fluid output or check for irregularities. More Getty Images, Aleksandr Kharitonov Have any health systems actually solved this problem? In recent years, more health systems and technology companies have been working to reduce cardiac-surgery-associated AKI—but "no one system has perfected this," Engelman said. At his system, Baystate Health, cardiac surgery-associated AKI has drastically decreased. The organization took an "aggressive approach" to tackle the problem, and for more than seven years, it has seen half the AKI incidence predicted by the Society of Thoracic Surgeons' database. "A decade ago, you would always see one dialysis [machine] outside one patient room," Engelman said. "Now, we use very, very little dialysis. It's pretty much unheard of to come in for elective cardiac surgery and need dialysis—and that includes patients who have chronic kidney disease." When a patient is screened in a cardiac surgeon's office at Baystate, they are also screened for any kidney malfunction, including baseline labs and urine output. The earlier a patient is identified as high risk, the earlier a surgeon can intervene and prevent them from developing AKI, Engelman said. The health system has increased emphasis on pre- and postoperative care—as have Lobdell's teams at Atrium Health. In 2023, he contributed to a literature review that outlined the evidence for "renal protective strategies." These include holding nephrotoxic medications that could harm the kidneys, setting specific goals for urine and cardiac output and following specific protocols when those goals aren't met. The most important step has been counseling patients on the risks of cardiac surgery, Lobdell said, which includes performing a numerical risk assessment for renal failure: the most severe form of AKI. By discussing those risks in "simple language," physicians and patients can engage in shared decision-making and come to an informed conclusion about whether cardiac surgery is even the right choice for them. In 2002, Atrium Health's renal failure rate was three times higher than the national average, according to Lobdell. By 2016, the system had "largely eliminated" renal failure. How should health systems approach cardiac-surgery-associated AKI? It's not impossible to drive down cardiac-surgery-associated AKI, but it does take diligence—and now, there's a deadline approaching. With more than 40 percent of hospitals operating at a loss, CMS' new value-based payment models will increasingly penalize complications like AKI that prolong length of stay and drive readmissions. Starting in 2028, hospitals will be required to report Stage 2 AKI or higher through CMS' electronic quality measures program. Simultaneously, the TEAM model will bundle payments for certain heart procedures, making any deviation from expected outcomes a direct financial liability. Hospital C-suites are often disconnected from care providers on the frontlines, Lobdell said. He recommends that leaders zero in on their dialysis costs from the last year, then compare length of stay and readmissions data for patients who developed AKI and patients who did not. "As we know, it's a linear relationship," he said. Surgeons and their teams have a lot on their plate, and they may not realize the financial burden that AKI has on their institution—or its impact on patients' quality of life. Once health systems have synced on the numbers, they can work to lower them, Lobdell says. "A big take-home message I like to give cardiac surgeons is that any kidney damage—[even] Stage 1 and Stage 2 AKI—is not acceptable," he said. "It's not reported to our databases as a problem, yet these patients' lifespans have been irreversibly reduced." "Any kidney damage is irreversible. Those nephrons are gone forever."
Yahoo
10-02-2025
- Health
- Yahoo
Centers Health Care launches educational hub for CMS' TEAM model
US-based Centers Health Care has launched an educational hub, named 'Are You TEAM Ready', to support the upcoming mandatory Transforming Episode Accountability Model (TEAM) by the Centers for Medicare and Medicaid Services (CMS). This initiative is designed to prepare healthcare providers and hospitals for the transition to value-based care, with the model set to begin on 1 January 2026. TEAM aims to facilitate collaboration across the care continuum to improve patient outcomes while reducing costs and hospital readmissions. The hub provides a resource for care managers, hospital administrators, and clinicians to help them navigate the new model, which emphasises efficient, episodic care management and partnerships with long-term care providers. The 'Are You TEAM Ready' checklist is a key feature of the hub, offering guidance on assessing and selecting long-term care partners. The hub also serves as a repository for recent articles on TEAM. Centers Health Care CEO Kenny Rozenberg said: "As a leader in long-term care, we recognise the critical role hospitals play in the continuum of care. "Our TEAM Educational Hub is designed to help our hospital partners prepare for this significant shift in health care financial management." Aligning with federal healthcare goals such as those outlined in Medicare's Bundled Payments for Care Improvement (BPCI) Advanced and other alternative payment models, TEAM highlights the importance of post-acute care in patient recovery. Selecting a skilled nursing facility (SNF) partner or suitable long-term care is critical for hospitals to support TEAM's objectives. Centers Health Care chief sales officer Steve Carr said: "While the CMS 5-star rating system offers valuable insights, it doesn't always capture the full scope of a skilled nursing facility's ability to deliver optimal outcomes for specific patient populations. "Hospitals must take a proactive approach by thoroughly evaluating potential SNF partners and critically examining their complex care capabilities, available resources, and track record.' "Centers Health Care launches educational hub for CMS' TEAM model" was originally created and published by Hospital Management, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site. Sign in to access your portfolio
Yahoo
07-02-2025
- Health
- Yahoo
Centers Health Care Launches "Are You TEAM Ready" Educational Hub to Empower Hospitals Navigating TEAM (Transforming Episode Accountability Model)
BRONX, N.Y., Feb. 7, 2025 /PRNewswire/ -- Centers Health Care, the largest and most complete post-acute health care continuum in the Northeast that touches one million lives each year with 45 skilled nursing and rehabilitation facilities, is proud to announce the launch of "Are You TEAM Ready," an Educational Hub focused on Centers for Medicare and Medicaid Services' (CMS) new mandatory Transforming Episode Accountability Model (TEAM). This initiative aims to educate hospitals and health care providers in delivering value-based care by offering insights, resources, and best practices for managing episodic care efficiently. The mandatory bundled payment model for select hospitals is set to begin on January 1, 2026. Hospitals across the country are taking this year to prepare for TEAM, which will emphasize collaboration across the care continuum, ensuring optimal patient outcomes while reducing costs and unnecessary hospital readmissions. The TEAM Educational Hub is designed to bridge the gap between acute and post-acute care settings by equipping hospital administrators, care managers, and clinicians with the knowledge needed to navigate this transformative model, including partnerships with long-term care providers. Key Features of the Centers Health Care TEAM Educational Hub Include: Are You TEAM Ready Checklist: Guidance on assessing and selecting long-term care partners. Tracking the Conversation: A hub of recent articles on TEAM. "As a leader in long-term care, we recognize the critical role hospitals play in the continuum of care," said Kenny Rozenberg, CEO of Centers Health Care. "Our TEAM Educational Hub is designed to help our hospital partners prepare for this significant shift in health care financial management," By aligning with broader health care goals to enhance care quality and control costs under federal programs such as Medicare's Bundled Payments for Care Improvement (BPCI) Advanced and other alternative payment models, TEAM highlights the critical role of post-acute care in achieving successful patient recovery. Choosing the right long-term care or skilled nursing facility (SNF) partner is essential for hospitals, as a strong partnership can reduce patient length of stay and readmission rates, supporting TEAM initiatives and enhancing overall patient well-being. Each year, Centers Health Care successfully treats and discharges over 10,000 rehab patients, empowering them to return home and reconnect with their loved ones. This achievement is fueled by the exceptional rehabilitation and therapy provided across its facilities, positioning the system as an ideal hospital partner with a proven ability to excel in short-term quality measures. "While the CMS 5-star rating system offers valuable insights, it doesn't always capture the full scope of a skilled nursing facility's ability to deliver optimal outcomes for specific patient populations," said Steve Carr, Chief Sales Officer at Centers Health Care. "Hospitals must take a proactive approach by thoroughly evaluating potential SNF partners and critically examining their complex care capabilities, available resources, and track record. The TEAM Educational Hub is now live and accessible to all health care professionals. To learn more, visit or contact Steve Carr at scarr@ About Centers Health Care Centers Health Care, one of the most complete post-acute health care organizations and a leader in post-acute care in the northeast, the company is a premier network of skilled nursing, rehabilitation and senior care services with 45 locations throughout New York State, New York City and Southern New Jersey. For more information about Centers Health Care, please visit Contact: Maryellen MooneyGoodman Media International, Inc. for Centers Health Care212.576.2700, x7255mmooney@ View original content to download multimedia: SOURCE Centers Health Care Sign in to access your portfolio
