The step down from the hospital to a post-acute care facility is one of the most challenging junctures in the patient journey. We looked at this transition from both the patient’s perspective and the hospital care coordinator’s perspective in a recent blog post and identified lack of information about post-acute providers and the quality of their care as the key obstacles. In our most recent thought leadership webinar, “Follow the Patient, Predict the Outcome,” we spent some time discussing this transition from the skilled nursing facility’s perspective. During the webinar, I teamed up with our Vice President of Post-Acute Providers to review the regulatory programs currently impacting the SNF industry. Because these programs all include publicly reported quality measures, they have the potential to close the information gap and make the transition to post-acute care smoother—if SNFs can provide context for their performance scores and proactively communicate their value to patients and partners.
Shifting Expectations for SNFs
Historically CMS has only held SNFs accountable for how their patients are doing during their post-acute stays. But there are now multiple Medicare programs that extend the period that a SNF is responsible for its patients, signaling a shift in policy. The SNF Value-Based Payment (VBP) Program, the Quality Reporting Program (QRP), and the Five-Star Rating Program all include measures with a period of assessment running 30 days from admission, meaning that some portion of the measurement window occurs outside the SNF. The Five-Star Program goes even further, including a measure on successful discharge back to the community that looks at the 30-day period post-discharge, meaning that the entire measurement window occurs outside of the SNF. (Download our webinar on SNF quality measures to learn more about how to follow patients post-discharge.)
Performance on New CMS Measures
Given that SNFs haven’t traditionally had to follow patients outside of their care setting, it’s no surprise that they’re scoring lower on these new measures. This is particularly evident with the Five-Star Program. Launched in 2008, the program is constantly in flux and was recently altered to add three claims-based measures with measurement windows that include time outside the SNF. The scores on these new measures—rehospitalization, ED visits, and successful discharge back to the community—are significantly lower than those on the program’s more traditional MDS measures. Out of a total possible 100 points, on average most SNFs are only scoring in the 50s.
The (Disproportionate) Significance of the Five-Star Program
Performing well in the Five-Star Program needs to be top of mind for all SNFs, because the number of stars granted to a facility has come to be viewed by patients and referral partners alike as the key indicator of quality of care. During our recent webinar, we discussed a study conducted by CarePort’s data analytics team that revealed a direct correlation between the number of stars a SNF has earned and both its occupancy rate and Medicare census. Facilities with fewer stars consistently had lower occupancy rates and a lower Medicare patient census. In 2016, for example, facilities with one star had an average occupancy rate of 79% and an average of 98 Medicare admissions. Compare this to facilities with five stars, which had average occupancy rates closer to 82% and an average of 163 Medicare patients. It’s unclear whether this is a case of the chicken or the egg coming first—Is it having the stars that attracts more patients, or do the additional funds from higher occupancy make it easier to earn a five-star rating? To some degree the answer to this question is irrelevant. What’s important is that the relationship exists, making the Five-Star Program a highly influential performance indicator – and a program with important measures that require SNFs to monitor patients after leaving their facilities.
Strategies SNFs Can Use to Tell a More Comprehensive Story
The Five-Star Program shouldn’t be considered be-all and end-all representation of a SNF’s quality, because quality is just one of the three domains (the other two are survey and staffing) and is only weighted approximately 18% towards the overall rating. Another downfall of relying solely on a facility’s star rating is that the claims-based measures used in the Quality domain are only based on the Medicare fee-for-service patient population. If traditional Medicare patients are only a small percentage of a facility’s total population, the number of stars awarded to that facility does not paint a complete picture. Shouldn’t we be tracking a readmission measures that tracks the Medicare Advantage population? As the MA population continues to grow is will further diminish the value of fee for service claims-based measures.
Given that the stars are not necessarily the most complete picture of quality—and that SNFs are also working hard to satisfy requirements of less well publicized programs like the VBP and QRP programs–SNFs need to find other ways to tell their quality story. In our post on the patient experience during the transition to post-acute care, we explained the role technology can play in closing the post-acute information gap. It does this by providing SNFs with a mechanism for showing their worth more comprehensively. By populating their profile in CarePort Guide, SNFs ensure that both providers and patients are aware of what they have to offer outside of their star rating, such as specialized clinical care capabilities, insurance partnerships, amenities, and more.
Additionally, SNFs can close information gaps and improve performance on measures that look outside of their SNF, for all of their patients, with no lag time, by tracking their patients through CarePort Connect. With CarePort Insight, they can be sure that their performance on key metrics such as readmission rates and length of stay by discharge disposition is captured and available for referral partners to view as they assess facilities for inclusion in their preferred networks.
When all stakeholders engage with the same care coordination technology—patients, care coordinators, acute providers, and post-acute providers—the transition from the hospital to a SNF and beyond can go from being disorganized and stressful to seamless.
Are you a SNF participating in one of these programs? Learn more about CarePort’s full suite of solutions for post-acute providers.