In the face of the changing payment landscape, skilled nursing providers can’t afford to put off data collection.
In fact, there’s a lot of information gathering they must be doing now to adapt to value-based payments, Bundled Payments for Care Improvement (BPCI), the rise of Medicare Advantage (MA), and a host of other changes, Leah Killian-Smith, director of quality and government services at long-term care consulting firm Pathway Health Services, said Tuesday in a session at the annual LeadingAge Illinois conference.
“Whether you’re a standalone facility… or you’re a big organization that has an electronic dashboard, we all need data to do our jobs correctly” Killian-Smith said at the event, held in Schaumburg, Ill.
Change in the air
Multiple factors are driving changes in the long-term care arena, including rising costs, a lack of data, an increased emphasis on care coordination, and ramped-up regulations and expectations, Killian-Smith explained.
Nursing homes now have to focus on the continuum of care, she said, in addition to caring for hospital-level patients — with essentially the same staff skill level that they had for the custodial care model two decades ago.
“Now is the time that we actually do have to step up and pay attention, because if we don’t, there will be financial ramifications for the decisions that that we will be [making],” she explained.
This was particularly highlighted by the skilled nursing facility prospective payment system (PPS) final rule, under which eligible SNFs will be granted value-based incentive payments for the quality of care provided to Medicare residents starting in fiscal 2020. These policies include a payment performance period that began in October 2017 and will end Dec. 31, 2019.
Under the new system, SNFs will automatically see 2% of their Medicare reimbursements withheld, with the ability to earn it back by meeting certain performance metrics.
Based on how SNFs perform in the program, 60% of the total amount withheld from their Medicare payments for fiscal 2020 will be distributed as incentive payments to the facilities. That portion means the Centers for Medicare & Medicaid Services is saving a significant amount of money, and how SNFs fare will be determined by the steps SNFs take in the immediate term, Killian-Smith explained.
“What you’re doing right now, today, is going to be the measurement for those dollars in 2020,” Killian-Smith said.
LTC providers can get preferred status with local hospitals if they can take sicker patients faster, and to that end, hospitals have to know a facility’s clinical capabilities, Killian-Smith said.
Hospitals are also looking for providers that make the discharge process easy, and it’s in this transition process that SNFs could shine — if they have strong data to show acute-care leaders.
“You have to go out and sell your beds now,” she said. “You do have to go ask for admissions, you have to go tell the hospitals what you do better than anybody else. And they’re not supposed to have preferred people to tell you where you’re supposed to go… but a lot of times, it’s wherever it’s easiest to get the resident through the process,” she said.
In addition to using data for referrals, gathering information allows SNFs to get ahead of the wave of alternative payment models (APMs) and value-based payments (VBPs).
“There’s endless possibilities on being preferred providers,” Killian-Smith said. “One is risk-shared agreements. A managed care organization will say: If you meet this set of criteria… we’re going to put you on our preferred list of providers, but we’re going to risk-share some of this.”
Written by Maggie Flynn