How Skilled Nursing Providers Can Win Under Value-Based Purchasing

Skilled nursing facilities have until October to prepare for the new Value-Based Purchasing (VBP) model, and the stakes are high: Starting this fall, SNFs will automatically lose 2% of their Medicare funding, which they can earn back by hitting certain key quality benchmarks.

Providers that have already participated in risk-based accountable care organizations (ACOs) will have a leg up come the start of fiscal 2019, Kathleen Griffin, president and CEO of consulting firm Care Management Innovations, said during a Tuesday panel discussion at the Post Acute 360 conference in National Harbor, Md.

“Once you’re in that market, everything changes,” Griffin said. “Suddenly those 15-member networks go down to three.”


In order to set themselves apart in those narrow networks, the best SNFs have already taken steps to lower readmission rates — a key metric under the looming VBP model — and make other internal improvements that will help them preserve their reimbursements in the future.

In particular, Griffin pointed to three essential areas where SNFs should focus between now and October.

Medical coverage


Under VBP, nursing homes will be responsible for the entire 30-day period following hospitalization, and will be penalized if a specific resident returns to the hospital during that timeframe — even if the person was under the care of a home health organization.

Avoiding those hospital trips begins with solid medical staff on the SNF level, Griffin said. She personally believes strongly in the so-called “SNFist” model — primary-care doctors that specialize in working in the skilled nursing setting — but coverage can also take the form of physicians’ assistants and other consistent medical staff.

“You just have to have the medical coverage,” Griffin said. “There’s a reason they do rounds in hospitals.”

Nursing know-how

Finding quality nurses has been an ongoing headache for operators, and the pain will only get worse if a provider’s nursing staff isn’t trained to meet the higher standards coming down the pipeline.

Tim Lehner, senior vice president of operations for provider S&F Management Company, noted that nurses frequently make the decision to call for hospital readmissions — making their expertise even more vital. His company has partnered with the Kaiser Permanente health system at its Northern California buildings, in part to help boost nurse competency.

“These are different patients that are coming in from the three-days-and-a-knee-replacement,” Lehner said of the higher-acuity patients that his company’s buildings frequently accept. “So we’ve really had to bring the level of our nurses up, and the training with our nurses up.”

Griffin, for instance, has seen a hospital share its training materials for nurses with SNFs, helping the post-acute staff to understand the hospitals’ standards and challenges. Those kinds of partnerships are integral to success in boosting a building’s nursing capabilities, Griffin said.

“When we go into these narrow networks, we miss the boat on the partnership piece,” she said. “This is not a one-way partnership. This is a two-way partnership. We haven’t asked the hospitals to help us out.”

Family matters

Competent doctors and nurses are still no match for a family that doesn’t understand their loved one’s personal goals. That’s where a quality medical director at a skilled nursing facility comes in: He or she can provide the kind of steady guidance that will deter the child of a resident from insisting on sending him or her back to the hospital, regardless of whether it’s clinically necessary.

“You can’t have a family that wants Mom going to the hospital,” Griffin said, emphasizing the importance of clear leaders at SNFs. “They’re the ones that need to assure the family that whatever their loved one needs can be done in that skilled nursing facility most of the time.”

Written by Alex Spanko