At the recent American Case Management Association (ACMA) Leadership and Physician Advisor Conference, a common theme was how hospitals and health systems can leverage upcoming skilled nursing facility quality incentives to achieve more engagement and information sharing from their networks. Through the Skilled Nursing Facility Value-Based Purchasing Program from Medicare SNFs will be eligible for incentive payments starting in 2019, based on activity in 2018. The incentives are based on improvements to hospital 30-day readmission rates for patients with stays at the particular facility, regardless of whether the SNF transferred the patient to the hospital or discharged the patient to home.
Dr. Ana Mola, Director of Care Transitions & Population Health Management at NYU Langone Health, spoke to the challenges of coordinating care with post-acute providers. According to her, a patient undergoing surgery could have as many as 27 different providers involved during the recovery. To help address these challenges, NYU set a goal to improve their collaboration with skilled nursing facilities.
NYU leveraged the upcoming SNF incentive payments to encourage participation in value-based care right now. They created a preferred network of 11 high-quality facilities that come together quarterly to work on improving care transitions. In order to be part of the network, the SNFs must openly share quality data such as length of stay and readmission rates. Even though these facilities are in competition with each other, Dr. Mola has found that they are willing to share their data because the open conversation helps each facility improve and prepare for the upcoming incentives.
Deep dive with NYU Langone: Redesigning Care for Better Outcomes
Julie Mirkin, Vice President for Care Coordination at New York Presbyterian also spoke to the need to improve care transitions. At NYP, they funded a care coordination department and organized all care managers and social workers under the department. They also created committees on post-acute strategy and transitions of care that monitor the performance of their post-acute providers and engage them in quality improvement.
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Dr. J. Brent Myers from ESO Solutions anticipates that the new Medicare incentives to prevent readmissions will encourage SNFs to find alternatives for providing acute care. Perhaps SNFs will explore options for treating in place at the SNF; for example, by contracting with an emergency response company to provide on-site medical support during shifts without a staff MD on premises. Per Dr. Myers, studies already exist that suggest on-site treatment by emergency responders for hypoglycemia and narcotic overdose can lead to better health outcomes than transfer to a hospital. Dr. Myers posits that this may be true for other medical conditions as well, such as cardiac arrest.
The Skilled Nursing Facility Value-Based Purchasing Program provides SNFs with a new incentive to provide quality information to hospitals and to work collaboratively to keep patients from being hospitalized. Hospitals and health systems are leveraging this program to ask for more engagement from their SNFs, more data on quality of care, and more information on their shared patients. When hospitals and SNFs work together, everybody will realize the benefits.
CarePort can help set up and manage preferred provider networks. Request a demo.