Medline recently hosted a distinguished panel of thought leaders at our Post-Acute Care sales meeting. Hailing from both post-acute and acute care, these experts gathered to discuss care transitions, challenges and new healthcare models that are driving better care for patients across the continuum of care, sharing expert opinion and real-life behind-the-scenes looks at the challenges that post-acute care facilities are facing.
As a result of the Affordable Care Act, Medicare is shifting its reimbursement model to hold providers financially accountable for quality and value. In 2013, only 42 percent of all Medicare fee-for-service payments were tied to quality. But by 2018, the U.S. Department of Health and Human Services (HHS) seeks to have 90 percent of these payments tied to quality.1 The panel agreed that providers must work together in order to improve care coordination and transitions among the various care settings. Medicare’s shift in focus will lead to new opportunities for hospitals, health systems and post-acute care providers to collaborate on care planning and share accountability for patient outcomes.
So what does that mean out in the “real world” of care providers? We asked our panelists to share thoughts on everything from what challenges them the most with the current changes in healthcare to what suppliers can do to be better strategic partners. When looking at which skilled nursing facilities (SNFs) to partner with, acute care providers will look for SNFs that demonstrate they can confidently care for high-acuity patients, have low readmissions, can coordinate care with the patients’ physicians within a certain time period, and can report on quality data such as falls, pressure ulcers, and UTIs. While there is currently a wide spectrum of sophistication in SNFs, this new environment will naturally whittle down the selection.
Length of stay (LOS) was also a discussion point among the panel, as providers in some states are required to reduce the number of days a patient is cared for in either a hospital or SNF, and Medicare stops paying after 20 days. According to what Genesis Healthcare Senior Vice President of Development Michael Wylie personally believes, patients are getting discharged too soon under the current rule for the state of Massachusetts, which requires an average LOS of 7 days. Michael’s hopes are that over time, healthcare workers will base decisions on what each individual needs and discharge when appropriate for each patient, rather than conform to a specific timeline or formula. Craig Abbot, CEO of Health Dimensions Group, agreed, stating that a better approach would be to take a time out from the numbers and go back to focusing on the people who need care. Don’t let the data, payers, or providers dictate what fits the patient best.
Tom Coble, the CEO and founder of Elmbrook Management Company, highlighted the fact that education is paramount, since changes in healthcare have created issues specific to the post-acute care industry that other industries do not need to deal with. He also noted that providers should pay special attention to providing resources and education on improving care transitions in rural areas, since many residents are part of a Managed Medicare or Medicaid plan that holds providers accountable for providing more efficient care with improved outcomes.
All of our panelists agreed that in their selection of care partners, hospitals and payers are limiting referrals to post-acute care providers that match the hospitals’ benchmarks for cost-effective care and optimal outcomes. The good news is that Medline can assist many providers in creating further quality and value, thus becoming more appealing to a network. According to Craig Abbot, Health Dimensions Group moved to Medline because they saw an opportunity for us to work together in a way that enabled Health Dimensions to better demonstrate their ability to provide cost-effective, high quality care that aligns with hospital goals. Through Medline programs like abaqis® quality management system and Medline University, Health Dimensions will be able to create and implement a plan to put them ahead of the competition and help ensure long-term business success. Care transitions can be difficult. They are complex with a lot of moving pieces, which means that facilities of all sorts are searching for industry partners who can help make it easier to do the right thing.
One thing is for certain: The changes to the healthcare landscape are not going away. Facilities must adapt or they may be passed over for partnership opportunities. How are you managing the changing healthcare landscape? What are some of your challenges when it comes to hot topic issues such as managing care transitions?
- Centers for Medicare & Medicaid Services. Better Care. Smarter Spending. Healthier People: Paying Providers for Value, Not Volume. Available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html. Accessed June 7, 2016.