New Bundled Payment Models Could Shove Out SNFs

Post-acute care providers will have to adapt to a bundled payment system that gives primacy to hospitals and physicians — and to do that, they’ll have to prove their value to a host of partners, according to a recent blog post from the National Investment Center for Seniors Housing & Care (NIC).

The Centers for Medicare & Medicaid Services (CMS) introduced the new Bundled Payments for Care Improvement Advanced (BPCI Advanced) earlier this month. Participants in the voluntary program, which replaces the existing voluntary BPCI models, can receive payments for 32 clinical episodes of care, including additional outpatient episodes.

“Participating skilled nursing providers in BPCI 3 may be disappointed to be taken out of the driver’s seat, since many providers adapted systems and made investments in staff and capabilities to maximize the benefits under the voluntary model,” Liz Liberman of NIC wrote in the blog post. “CMS has not given any indication that a post-acute driven model should be expected in the future.”


The skilled nursing industry has expressed disappointment that SNFs and home health agencies could not be episode initiators, but there are opportunities available for skilled nursing providers to develop new partnerships, Liberman said. Those providers that can offer high-quality care that avoids rehospitalization at a low cost will be in the best position to take part in bundled payment arrangements, she said.

Players in the skilled nursing field are aware of the need to work together to reduce hospitalizations, and Liberman noted that any new partnerships under BPCI Advanced could be defined by pressure on providers to minimize length of stay while keeping up quality standards set by the convening partner.

“Furthermore, as hospitals and physician groups join BPCI Advanced, overall admissions to skilled nursing could decline as these entities may want to limit post-acute care spending to reap the maximum benefit from CMS,” she wrote. “Convening entities may look to home health agencies in place of skilled nursing altogether, and when possible, may even opt out of any post-acute care services.”


But skilled nursing providers that can distinguish themselves could thrive; skilled nursing operators could see benefits through partnering with home health and coordinating post-acute care, she said.

“Likewise, providers already demonstrating good outcomes and low readmission rates for specific conditions may be valuable to partners aiming to participate in BPCI Advanced for the same conditions,” Liberman wrote.

Editor’s Note: An earlier version of this story featured an incorrect spelling of Liz Liberman’s name. Skilled Nursing News regrets the error.

Written by Maggie Flynn

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