Applying CMS’s new SNF Five-Star measures to a preferred network program

What will new changes to the Five-Star Quality Rating system for skilled nursing facilities (SNF) announced by the Centers for Medicare and Medicaid (CMS) mean for your organization?  How will these changes impact your post-acute care practices?

In March, the Centers for Medicare and Medicaid (CMS) announced new improvements to the Five-Star Quality Rating system for skilled nursing facilities (SNF) that brings tenets of the Hospital Readmissions Reduction Program into view for skilled nursing homes.

This newly available quality data provides a more comprehensive view of SNFs and represents a leap forward in providing the necessary information to improve post-acute outcomes.

Evaluating nursing homes’ ability to rehabilitate patients

With the new additions to the Star measures, CMS is moving toward an evaluation of facilities based on not only their ability to help patients get well but also to stay well once discharged home. These additional measures include the following:

  1. Percentage of short-stay residents who were successfully discharged to the community
  2. Percentage of short-stay residents who have had an outpatient emergency department visit
  3. Percentage of short-stay residents who were re-hospitalized after a nursing home admission
  4. Percentage of short-stay residents who made improvements in function

Applying Five-Star Quality ratings to improve your organization’s post-acute management strategies. 

SNF outcomes vary widely, so it’s important to understand these metrics as they relate to your organization’s referral partners. This is especially critical for organizations interested in adopting network and preferred providers strategies.

While top performers (10th percentile) reported readmission rates as low as 5.7%, the worst performers (90th percentile) sent nearly 1 in 5 patients back to the hospital.[i]

Variability in care delivery quickly adds costs as each readmission is estimated to cost on average $10,000. A corresponding measure – discharge to the community – demonstrates how often a facility can successfully rehabilitate patients without the patient returning to a hospital or dying within 30 days.

In 2012, the average community discharge rate was 30.6%. Yet this measure varied from 15.7% for providers in the 10thpercentile to 43.9% for providers in the 90th percentile. Finding the facility that returns patients to their homes quickly and without subsequent readmission represents a potential reduction of tens of thousands of dollars.

Leveraging these new nursing home measures is a great starting place for developing preferred provider programs.

The strength of this data is that it is objective and publicly available. The limitations are that it is not hospital or patient-population specific. For example, a facility’s quality metrics may differ based on patient diagnosis or patient attribution (ACO, bundled payment, etc.). One of the ways that CarePort works with health systems to plug this hole is with its Patient Tracking tool, which collects in real-time post-acute outcomes across patient populations.

How can you guide your patients to better quality care? 

Imagine being able to share this quality of care data with patients and families during the discharge planning process. Increased transparency of SNF quality of care information helps patients prioritize quality when choosing care, rather than focusing on convenience. Hospitals have the opportunity to guide patients in selecting post-acute providers with lower readmission rates, ED utilization, higher gains in function, and rates of discharge back to the community.

These new SNF measures will be available as part of the CarePort post-acute provider selection tool and will complement existing information available on the tool, including clinical services, accepted insurances, amenities, photos, and virtual tours. In a few easy steps, patients and caregivers can search for providers, matching location preferences, required clinical services, and insurance needs.

In this way, your organization can easily leverage the CMS’s Five-Star Quality Rating system for skilled nursing facilities to improve patient outcomes, while also reducing patent care costs. This benefits everyone: the patient, the discharge planner, the post-acute provider and the health system.

[i] Medicare Payment Advisory Commission (MedPAC), prepared by Providigm, LLC. “Development of Potentially Avoidable Readmission and Functional Outcome SNF Quality Measures.” March 10, 2014.

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