Tom Price is now confirmed as the secretary of Health and Human Services, a $1 trillion agency. Yet, questions remain as to what’s next for healthcare as Price has been vocal about his unfavorable opinions of the Affordable Care Act. While we wait, there’s one road ahead we can likely map out now: quality measures for long-term care.
The formal process of repealing the ACA is already underway, but so is the shift to the value-based purchasing from a fee-for-service system. The plan from the Centers for Medicare & Medicaid Services called for 50 percent of payments to be based on how well patients are cared for by 2018.1 Meanwhile, dozens of senior advocacy groups have spoken out to congressional lawmakers about keeping the elderly in mind when drafting new policies.
It’s not to say there won’t be some changes, but here is why quality will still be a key component.
1. The benefits to the providers are not very pronounced when it comes to repealing the readmission penalty. A 2016 study in the Journal of the American Geriatrics Society honed in on three areas of special concern for Skilled Nursing Facilities (SNFs). First, was a lack of communication whether it was between hospitals and SNFs or SNFs and the patients/caregivers. Second, was the potential for patients being kept longer than they need to be and the third was a lack of research evidence to support assumptions for the CMS mandate.2
2. The vast majority of hospitals or referral sources for nursing homes have already moved down the road to narrow their networks, and this is forcing nursing homes to have to act differently. SNFs must watch readmission rates, quality measures and determine if they are able to conduct disease management. These are all the factors hospitals are requesting. The facilities must be able to report on these priorities in a systematic way because hospitals are finding they prefer the collaboration in the narrowed networks. They’re becoming dependable resources for the acute care hospitals and are already seeing greater outcomes for patients because of the shift.
My suggestion for SNFs, in their journey to move from a fee-for-service system to a higher quality model, is to have the proper monitoring plan to track reliable data sources that will tie into key metrics that referral partners are seeking. This includes readmissions, length of stay, survey results, five-star quality rating, customer and family satisfaction as well as disease management.
Facilities will need to prove they can communicate with the referral sources by using clinically accepted forms like the INTERACT SBAR transfer form and communication form will help the lines of communication, medicine reconciliation, advanced care planning and show that you can communicate your quality assurance plans within your building. For now, readmission reduction is moving forward. You’ll see a continual change on the importance of five-star ratings and how that affects facility census, an indication that you need to have really great quality to attract consumers and referrals.
Even if the new administration repeals all of the ACA, quality is still going to be foremost a priority for good skill building.
Is your facility prepared to offer these forms of communication?
1. Better Care. Smarter Spending. Healthier People: Paying Providers for Value, Not Volume, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html, Centers for Medicare & Medicaid Services, January 26, 2015.
2. Hospital Readmission Penalties: Coming Soon to a Nursing Home Near You!, http://onlinelibrary.wiley.com/doi/10.1111/jgs.14021/abstract, Journal of the American Geriatrics Society, March 21, 2016.