By BRIAN HOLZER MD, MBA
Leaders in hospitals and health systems as well as post-acute care providers such as skilled nursing facilities (SNFs) and Home Health Care (HHC) agencies operate in a complex environment. Currently, the health care reimbursement environment is largely dominated by fee-for-service models. However, acute and post-acute leaders must increasingly position their organizations to prepare for, and participate in, evolving value-based care programs—without losing sight of the current fee-for-service reimbursement structure.
With that said, the call to action for acute and post-acute providers working at both ends of the reimbursement spectrum is real. The time is now to innovate, test and adopt new post-acute care models to support each patient’s transition from hospital to post-acute settings, and eventually home to enable a better care experience for patients and their care teams.
This is especially relevant for Skilled Nursing Facilities (SNFs) and chains that meet the current Medicare requirements for Part A coverage. Increasingly, the SNF industry is under pressure from the Medicare program to improve coordination and outcomes. Medicare’s hospital readmission policy and value-based purchasing program (VBP), bundled payments, and ACOs encourage SNFs, and other post-acute settings, to avoid readmissions. In addition, earlier this year, the Centers for Medicare and Medicaid Services (CMS) finalized a new patient-driven payment model (PDPM) for SNFs, which will go into effect on October 1, 2019. The overhaul of the entire system will require significant staff focus and operational changes.
Care management solutions will be particularly helpful as SNFs operate under the recently imposed SNF VBP. Specifically, models that assist SNFs in reducing their 30-day hospital readmission measure and better manage performance scores, which may increase the facility’s Medicare incentive payments. This will undoubtedly require investments in internally developed and/or outsourced solutions that engage patients after discharge from the facility for a period of at least 30 days, whether or not the patient is under the care of a home health company. Telephonic patient engagement, in particular, with clinically trained resources during this 30-day period of time can serve to efficiently:
- Screen for fall risk and depression, and identify common gaps including concerns related to medications, home medical equipment, physician appointments, and necessary medical services such as home health
- Assess for site of care needs with coordination for patients who may be better served back in a SNF for a shorter therapy stay, which does not require another three-day hospital qualifying stay
- Assess for site of care needs with coordination for patients who may be better served in Home Health Care or assisted living or independent living residences, which can serve as appropriate alternatives to unnecessary emergency room visits or hospital readmissions
There’s an urgent need for additional post-acute care management services supporting holistic patient transitions and operations, and providers need to take actions now or run the risk that the decisions will be made for them. The time is now for acute and post-acute care providers to consider solutions that help deliver effective care management and improve patient engagement across the post-acute care continuum.