How Skilled Nursing Facilities Can Control Their Bundled Payment Destiny

Post-acute care (PAC) providers, including skilled nursing facilities, may be out of the driver’s seat in the new bundled payments program from Centers for Medicare & Medicaid Services (CMS), but that doesn’t mean they need to sit on the sidelines.

In fact, being proactive is one of the best things they can do position themselves for success in the world of Bundled Payments for Care Improvement Advanced (BPCI Advanced), according to Brian Ellsworth, director of payment transformation at the Minneapolis-based consulting firm Health Dimensions Group.

“The ideal scenario is to get a seat at the table right as this program is being designed, right now as the bundlers are completing their application,” he told Skilled Nursing News.


Positioned for success

Under BPCI Advanced, SNFs and home health agencies can’t be episode initiators; that role is confined to hospitals and physician group practices. But the success of bundled payments depends on post-acute care engagement, experts told SNN.

In the best-case scenario, SNFs and post-acute providers would position themselves to become a risk-sharing partner with bundlers in BPCI Advanced, ideally arranging this before the March 12 application deadline.


“They should be really focused on how they can take risk from the BPCI bundler — either partial or full risk — for the downstream post-acute services, and do so in a way that allows the BPCI Advanced bundler to comfortably take more risk than they might otherwise take,” Ellsworth said.

To be able to do this, SNFs and post-acute providers should be capable of full integration with the bundler’s approach to care. They also have to be able to successfully manage lengths of stay for patients and have strong protocols to prevent hospital readmission, Ellsworth said.

“And depending on how much risk they might be taking post-discharge, they would also potentially need some kind of care management infrastructure for once folks return to the community,” he added.

The first concrete step for PAC providers will be some investigative work, according to Ellsworth.

“They’ve got do some market intelligence right now about who’s considering this in their community — particularly their referring hospitals, but also if any physician groups are entertaining this,” he said. “Their big challenge is figuring out exactly who to talk to, but it’s usually kind of the population health or value-based type of person.”

Other indicators as to whether a physician group or hospital is considering participation include previous attempts at bundling or the adoption of an accountable care organization. But if a SNF can’t make the deadline, they shouldn’t give up.

“If it’s past March 12, you find out who has applied, and then seek to get a seat at their table,” Ellsworth said.

Proving value

SNFs and post-acute providers will have to prove their value to participants in this position. Having a proven track record with reduced length of stay, readmission prevention, and discharge management — with data to back it up — is the best-case scenario, Ellsworth said.

If this isn’t available, SNFs and post-acute providers should have a good explanation of their value, their strategic goals and quality scores. They should also show a willingness to integrate into the bundler’s care redesign strategy, Ellsworth said.

They can also distinguish themselves by helping hospitals deal with medically complex patients.

“To an extent that your facility is able to address hospital pain points around medically complex patients — and you have capabilities in that regard such as [intravenous] therapy — that becomes an opportunity for a more strategic conversation,” Ellsworth explained.

One thing is certain: In BPCI Advanced, PAC providers should be ready for action.

“One of the lessons learned from our experience over the past four years was that those providers that are proactive and seek out the opportunities have a greater chance of developing their own destiny,” Ellsworth said.

Written by Maggie Flynn

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