Using Medicare to Pay Care Coordinators — And Reduce Readmissions
The role of the care coordinator has frequently been floated as a way skilled nursing providers can navigate the new value-based care landscape.
By creating a position that’s solely focused on guiding residents through the transitions that occur on the long-term care continuum, the logic goes, providers can prevent costly hospital readmissions and improve the quality of care.
With shrinking government reimbursements and continued staffing pressures, hiring a dedicated care coordinator could be out of the reach of many providers. But one provider found a novel solution through a specific Medicare benefit, and believes it’s developed a clear solution for reducing rehospitalizations.
Juniper Communities, a Bloomfield, N.J.-based operator of senior housing properties with assisted living, skilled nursing, and memory care services, calls its care coordinators “medical concierges” (MCs) — a group of certified medical assistants (CMAs) and other professionals who serve as the point person between residents and health care providers.
Juniper has made a concerted effort to bring medical and rehab services directly to residents, through both primary care doctors and a partnership with a joint venture of Genesis Healthcare (NYSE: GEN). The MCs in particular act as a coach and facilitator for residents and the providers, according to Juniper founder and president Lynne Katzmann.
Using a Medicare code known as chronic care management (CCM), Juniper’s third-party primary care physicians can receive a Medicare reimbursement of $42 per member, per month to perform care coordination duties. While the physician has to be the person to enter the code, the Medicare rules don’t actually require him or her to perform the data collection, Katzmann said — allowing Juniper to use certified medical assistants to conduct the monitoring and face-to-face interactions required under the code.
“Those services include things like putting together a care plan, doing an assessment, and then doing at least 20 minutes of monitoring a month,” Katzmann said. “And they have to document that.”
Juniper allows all residents who use its primary care services to opt into the CCM program; about 75% to 80% take the company up on the offer, Katzmann said.
And so far, the numbers have borne out the logic. Among Medicare recipients who require help with at least one activity of daily living (ADL), Juniper residents had half the hospitalizations of the overall population, according to a 2017 analysis from consulting firm Anne Tumlinson Innovations — with 80% lower readmissions. Were the entire industry to adopt Juniper’s model, Katzmann said, Medicare would save $10 billion to $15 billion each year.
While the research explicitly excludes nursing home residents from the comparison data, the numbers provide a blueprint for how operators of all types can boost coordination with partners — an increasing pressure for SNF operators and others along the spectrum.
“In order to save money, ultimately what you need to do [is] manage their care across multiple providers and settings,” Katzmann said.
Written by Alex Spanko