For the past five years Medicare has been putting pressure on hospitals and physicians to improve transitions of care. They’ve had to conduct patient experience surveys, track readmission rates, and hire staff to follow up with patients after they leave the hospital.
Now Medicare has turned its sights onto skilled nursing and rehabilitation facilities. They can’t fly under the radar any more.
Starting in October 2018 their hospital readmission rate – that is, how many patients discharged to post-acute care settings are sent back to the hospital within 30 days for additional acute-care services – will be monitored.
The SNF’s rate of hospital readmissions will play a role in the calculation of its Medicare reimbursement. A low readmission rate can deliver a bonus; a higher rate of readmissions may lead to a penalty.
According to the Protecting Access to Medicare Act of 2014, more SNFs are likely to be penalized than rewarded. The new value-based payment regimen starts with a 2% decrease in Medicare per diem payments across the board, which funds the bonus pool. SNFs that score at the top of the distribution may qualify for a bonus as high as 2%. Those in the middle of the distribution will get part of that 2% back. SNFs that score below the 40th percentile of performance are not eligible for any incentive payment, and will see their payment from CMS trimmed by the full 2%. The total value of the incentive payments will not be more than 70% of the total amount of the payment reductions.
Thus, SNFs are forced to compete against each other to recover the decrease in reimbursements in this less-than-zero-sum game. To fall into the lowest two quintiles will have a measurable impact on payment and profitability, not to mention reputation in the community and among hospital referring personnel.
For the skilled nursing and rehab world, this presents a business challenge and a patient care challenge.
At the same time, it presents an opportunity for enterprising SNF managers to improve their facility’s reputation, retain staff, use labor resources more effectively, and build stronger relationships to patients and families.
Technology has emerged as a powerful tool to help extend the reach of providers in and beyond the clinical care setting and throughout the care continuum.
Since the passage of the Affordable Care Act in 2010, this trend has grown exponentially as hospitals and health systems adapt to value based care and juggle competing demands and priorities. These same technologies can be applied to the post-acute and rehabilitation sector, with the goal of raising a facility’s performance on these critical CMS metrics.
At a time when the skilled nursing and rehab industry is ill-positioned to add personnel or raise compensation, these kinds of tools can optimize the time of a clinical work force. The tools leverage technology to deliver consistent messaging to a facility’s patient population, while automating collection of select patient data from those patients.
They also increase the efficiency of nurses and caregivers by sorting out those patients who are progressing well on their own. That lets care teams devote their attention to those who need help the most.