August 9, 2017

Hospitals, SNFs align on lowering readmission rate strategies as value-based payments loom

Daily Briefing

    Some skilled nursing facilities (SNFs) are changing the way they provide care to avoid unnecessarily sending patients back to the hospital, Kristen Schorsch writes for Crain's Chicago Business.

    The shift comes as SNFs that participate in Medicare prepare to transition to a new value-based payment program, which is slated to start Oct. 1, 2018. Under the program, CMS will reduce by 2 percent the total amount of Medicare payments to SNFs to fund the value-based payment incentives. Facilities with readmission rates no higher than a certain percentage will earn back a portion of the payments.

    How do post-acute providers achieve success in episodic payment?

    According to Crain's Chicago Business, the financial hit to low performing SNFs could be significant, particularly for the more than 700 SNFs in Illinois. The state owes health care providers a total of $14.6 billion that officials did not pay during a state budget impasse that lasted for two years, so any further hits to SNFs' payments could exacerbate the issue.

    SNFs increase focus on keeping patients out of hospital

    In anticipation of the new payment model, some SNFs have increased their focus on keeping patients from being readmitted to hospitals. For instance, the Illinois-based St. Pauls House in January launched a so-called "high-acuity unit," under which a team of doctors and nurses visit with patients almost daily. So far, the facility is reporting good results: St. Pauls readmission rate dropped from 23 percent a year ago to 10 percent after the unit launched, Crain's Chicago Business reports.

    Andrew Kazmierczak, the executive director at St. Pauls, said, "Recognizing the increasing needs of our patients, mixed with the increasing pressure on us to reduce hospitalizations, we wanted to find a way to handle that."

    Some SNFs are turning to new technology to lower readmission rates. For instance, 19 SNFs advised by the consultancy firm Extended Care are using telemedicine to help monitor patients. Nurses at the facilities use computers that allow doctors to examine patients without actually being in the room.

    The Illinois-based Symphony Post Acute Network —which operates 28 SNFs in Illinois, Indiana, and Wisconsin—has made a significant investment in an electronic health record system to reduce its facilities' readmission rates. Donna Sroczynski, president of operations at Symphony, said the system allows physicians to monitor patients' progress electronically.

    Rethinking the SNF, hospital relationship

    SNFs are not alone in adjusting to CMS' value-based payment model: The Affordable Care Act created the Hospital Readmission Reduction Program, which launched in fiscal year 2013. The program aims to reduce the number of patients who are readmitted to the hospital within 30 days of initial discharge for several conditions by imposing a financial penalty on those with higher-than-expected 30 day Medicare readmission rates.

    As such, hospitals are rethinking their relationships with SNFs, and are strengthening relationships with those they feel are more likely to keep their patients from being readmitted. For instance, Bruce Elegan, CEO of Rush Oak Park Hospital, said officials are looking to reduce the number of SNFs to which its hospitals refer patients from more than 30 to about 10.The hospital system is also embedding nurses at some SNFs to curb readmission rates, Crain's Chicago Business reports.

    According to Elegant, the strategy has been effective: The readmission rate for congestive heart failure patients has declined from 50 percent five years ago to zero within the last six months.

    In addition, Crain's Chicago Business reports that hospitals and SNFs increasingly are communicating about patients before they are transferred from the hospital to the facilities, which has not always been a common practice. Some hospitals also have nurses on their staffs work at their partner SNFs, Crain's Chicago Business reports (Schorsch, Crain's Chicago Business, 7/29).

    7 key considerations for building a SNFist program

    Bundled payment programs, accountable care organizations, and other changes mean that cost-effective, high-quality care is more important to health system bottom lines than ever before.

    There are many ways to boost episodic quality and efficiency, but one of the most promising is by placing physicians in the skilled nursing facility (SNF) setting. This guide includes 7 considerations for health care executives to learn more about this strategy.

    Download the Guide

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