With the federal overhaul of Medicare reimbursement to skilled nursing facilities comes a new focus on patient characteristics and clinical needs. And to thrive in a world where payment for care is based on such information, SNFs have to have that information readily at hand — in a format that they can understand.
To that end, Consulate Health Care has been working on getting its technology capabilities up to speed for the new Patient-Driven Payment Model (PDPM) — which puts a premium on properly addressing patients’ clinical needs, rather than their minutes of therapy.
Getting a major SNF provider like Consulate ready for that shift requires working with software vendors, patient tracking systems, and health information exchanges, to name a few, across multiple states; the operator has 140 care centers in Florida, North Carolina, Virginia, Pennsylvania, Louisiana, and Mississippi.
“What PDPM has done has augmented our focus,” Consulate chief technology officer Mark Crandall told Skilled Nursing News. “It’s looking at quality metrics perhaps a little bit differently, and we want to make sure that it’s still seamless for our operators to be able to get that data, to make better decisions about the care that is being provided at the care center level.”
The PDPM prep built on work that was already in place at Consulate, which had clinical quality metrics available on dashboards for several years, Crandall noted. But as the federal rule “morphed” after it was announced and finalized, Consulate had to collaborate with software partners on configuration needs regularly. Some of the changes included upgrades to the core electronic health record system, and the way its EHR processed associated data.
Consulate has been working to augment the data warehouse that it already used to track quality outcomes for patients at a steady pace, but software vendors have had to be very reactive to Centers for Medicare & Medicaid Services (CMS) rule changes on the coding of the Minimum Data Set and other technical specifications, Crandall said.
Though “some blips” are to be expected with PDPM, Consulate is confident in its partners and in its readiness for the switch. It took work to get there — like all health care providers, Consulate is bound by the Health Insurance Portability and Accountability Act (HIPAA) and is primarily focused on the security of its patient data.
“Small startups who have gotten into the game because they knew PDPM was coming, or they knew that patient tracking and cohort tracking was going to be more and more important, they’ve jumped into the deep end,” Crandall explained. “And so we’ve had to work with them a little bit to get them to the point where they have an enterprise-level solution.”
One of the unexpected benefits, however, was the acceleration of connectivity, which he believes was a direct result of PDPM. Consulate maintains its data on premises, which allows it to share information easily with state organizations and its patient-tracking partners. The system also allows data to travel back and forth, enabling Consulate to receive and act on data for incoming residents immediately — rather than waiting for the transfer of a relational database from a cloud provider, Crandall said.
“We’ve got an advantage there, because we do store so much of our data on prem,” he noted.
That infrastructure includes a data center in Orlando and a backup in the Atlanta area, built to support a centrally served set of applications — and the 14,000 to 15,000 practitioners that the SNF provider supports.
“They need a simple and secure way to get to the data and the applications that they need on a daily basis,” Crandall said.
To do that at scale meant serving all of the information out of Consulate’s data center, rather than having it fragmented across several different places. The PDPM advantage of this system relates to collaboration; there are more consumers of that data now under the new model, such as pharmacies performing medication management, for example.
“There are a lot of different players that are involved, a lot of different providers that are involved in making sure we are as prepared as possible to deliver the highest quality of care that we can — and so for us, being able to deliver that data immediately, because we control it, is a big advantage,” he said.
From the corporate to the SNF level
One of the challenges has been getting timely data into Consulate’s warehouse, and interoperability issues became especially pressing when combined with the need for up-to-date numbers, Crandall noted.
“At first, the challenge was just really to get the timely data into our warehouse so we could act on it and it could feed various applications,” he said. “The interoperability was really a challenge; there really was no way to package and securely deliver that data on a timely basis, as well as making sure that only the people that should have access to that data have the access.”
The crucial part, according to Crandall, was providing decision information that operators and regional support need. To that end, Consulate had to set up communication channels and make sure practitioners had the access to the data, with secure tools.
One of the first steps was “blanketing” with simple and secure Wi-Fi.
In years past, that meant “blanketing” buildings in simple and secure Wi-Fi coverage. However, there’s been a maturing of the available technology, and PDPM has been a contributor. The electronic health record now provides data on care provided within a SNF, and other information has comes from referral partners related to the full continuum of care; then there’s lab data, diagnostic data, medication data, and others.
“All of these can exist in various systems, so for us to put it in front of a practitioner that’s actually working with a patient, such that they are as prepared as they can be for that patient to arrive at our care center — that’s the most important data that we’re talking about,” Crandall said.