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The Final Rule: The Next Generation of Quality-Driven Reimbursement

Posted on: May 1, 2017



SPECIAL EDITION ADVISOR: A HealthPRO®/Heritage Position Statement

“The Final Rule: The Next Generation of Quality-Driven Reimbursement”

HealthPRO®/Heritage is Well-Prepared to Assure Our Partners’ Success in a New Reimbursement and Classification Environment

CMS’ proposed next-generation reimbursement system has been revealed, and HealthPRO®/Heritage will set the pace as THE PREMIERE STRATEGIC PARTNER – ready to inform, guide, and help build strategy in response to proposed changes of the Final Rule, including the Resident Classification System, Version I (RCS-I).

Late last week on April 27, CMS outlined the Final Rule and Pre-Final Rule. Among the dramatic, all-encompassing proposed changes is the transition from RUGS-IV to RCS-1 that will take place in October 2018. As thought-leaders, these proposed changes come as no surprise to HealthPRO®/Heritage.

In fact, this shift to a quality-driven reimbursement system is directly aligned with the HealthPRO®/Heritage philosophy. For more than five years – since the onset of the IMPACT Act and the Triple Aim – HealthPRO®/Heritage has embraced clinical strategies, compliance programming, and an operational approach that puts us squarely in line with the expectations proposed in CMS’s Final Rule.

In short, we have already made the necessary changes to ensure YOUR success in the new world of health care reform as it will look in 2018 and beyond. You can trust HealthPRO®/Heritage to help navigate the turbulent road over the next 18 months and beyond.

Details related to proposed regulatory changes, including the inception of RCS-1, will be outlined by HealthPRO®/Heritage subject-matter-experts during an "Open Door” webinar on Wednesday, May 10 at 1:00 PM EDT. Register now!

Count on HealthPRO®/Heritage’s Experience and Proven Success
The proposed changes are expansive in both philosophy and application. The proverbial “Alphabet Soup” will be redefined. HealthPRO®/Heritage will work with our partners to decipher both the minute details as well as the fundamental big picture changes. Some of these elements include:
  • Patient-Centered Care
    While many other therapy providers have been driven by a minutes/utilization focus, HealthPRO®/Heritage is decidedly patient-focused, encouraging clinicians and managers to drive patient treatment plans based on clinical evaluation and need utilizing standardized, evidence-based testing, prioritizing patient-centric goals, etc.

    Important to note: Proposed changes from a minute-based system reflect this fundamental area of concern that has plagued the industry for years. Many studies and reviews concerning the “overutilization of therapy” and “thresholding” of therapy minutes are now in the spotlight. HealthPRO®/Heritage is proud to continue to uphold our position that patient-centered care that aligns with quality functional outcomes will continue to drive our therapy programming.

  • Data-Driven Decisions
    Since 1997, HealthPRO®/Heritage has focused on collecting outcomes and using these metrics to support clinical decision-making. Our sophisticated, proprietary documentation/outcomes reporting IT system continues to be the industry’s best platform for tracking, reporting, and managing metrics.

    Important to note: In 2014 – well before it was mandatory to do so – HealthPRO®/Heritage was the first to integrate CMS’ Care Tool into our proprietary documentation/outcomes tracking IT system, demonstrating our commitment to gathering, managing, and leveraging outcomes data (as defined by CMS).

  • Innovative Clinical Programming
    Over the past six years, HealthPRO®/Heritage has invested in the development of a full arsenal of proprietary, advanced clinical programs that support:
          – Positive functional outcomes;
          – Proactive LOS management;
          – Safe transitions in care; and
          – Rehospitalization mitigation measures

    Many other therapy programs may struggle with designing, implementing, and extracting data necessary to be successful in the new proposed world of RCS-1.

    Important to note: Reimbursement levels will be set based on clinical and functional parameters and will be tied to a facility’s ability to manage length of stay in the proposed Final Rule. This will require providers to have well-established clinical pathways/programs in place that can demonstrate measurable success.
  • A Comprehensive Perspective
    HealthPRO®/Heritage understands the larger landscape of comprehensive health care reform. As such, though it may seem these proposed changes will only impact the skilled nursing industry, downstream partners need to understand how the implications of the proposed Final Rule will impact the behaviors of SNF partners so they can prepare to align with the philosophical approach to caring for clinically complex patients, LOS management, rehospitalization rates, etc. that will ultimately impact cross-continuum relationships/networks.

  • Strategic, Innovative Partners
    HealthPRO®/Heritage forms true partnerships, because we believe that – in order to weather the storms of health care reform and other challenges that come our way – we must, first and foremost, be aligned with our clients’ values. Beyond simply providing therapy services, you can count on HealthPRO®/Heritage for our innovative, proactive approach to health care reform. Our organization offers solutions:
          – To understand how the proposed changes will shape the future of healthcare delivery
              and value-based reimbursement and to keep YOU in-the-know;
          – To support the operational, clinical, compliance, and strategic changes necessary to
              prepare for RCS-1;
          – To execute on care redesign strategies that will directly align YOUR facility with
              expectations outlined in the Final Rule.

Like many industry leaders, HealthPRO®/Heritage has navigated significant changes in healthcare over the past two decades. This upcoming set of challenges will be no different. HealthPRO®/Heritage is perfectly positioned to support our clients in keeping ahead of the curve as the Final Rule takes shape.


Important to note:
As PAC providers begin to digest the proposed changes, CMS is accepting comments on both the Final Rule for FY 2018 and the Pre-Rule for FY 2019 through June 26, 2017. HealthPRO®/Heritage will stay dialed-in as commentary and feedback from thought-leaders are gathered and reviewed. We look forward to what might perhaps be a unified system focused on improved healthcare delivery as a result of several systems and platforms contributing to what might be the future of post-acute care. Stay tuned! Read More

Tags: Heritage Healthcare, HealthPro, CMS, HealthPRO/Heritage, Advisor Newsletter, Advisor, RCS-1, Resident Classification System, Reimbursement System, RUGS-IV, The Final Rule

Webinar – Wellness: More Than Exercise

Posted on: April 26, 2017

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Tags: Heritage Healthcare, HealthPro, Health care reform, HealthPRO/Heritage, Wellness, Senior Health & Fitness, Webinar, Wellness Program, Community Wellness, Resident Engagement

SNF Operators: 2% Of Your Revenue Is At Risk!

Posted on: November 11, 2016

Are you ready for a Big Game Changer?  Health care reform mandates will directly impact your bottom line starting January 2017. As CMS rolls out the “SNF VBP Program,” SNFs nationwide may find themselves scrambling to protect 2% revenue.

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Tags: Heritage Healthcare, skilled nursing facility, HealthPro, CMS, HealthPRO Rehabilitation, CMS Update 2017, HealthPRO/Heritage, Senior Care, Advisor Newsletter, SNF Operators, Advisor

Build a Better 5-Star Rating One “Quality Metric” at a Time

Posted on: June 22, 2016

HH_c_V_Logo_O_-_RGB.jpgAs the PAC industry anticipates yet another change in July 2016 with the revision of the CMS “5-Star Rating System,” HealthPRO®/Heritage offers an innovative, solutions-oriented approach for PAC operators based on (1) a keen understanding of how the “5-Star Rating System” works, and (2) expertise in developing impactful clinical initiatives and programs that ultimately enhance key drivers of quality care.

Background
PAC operators who are focused on how to either maintain or improve their Star Rating have good reason to be concerned. The original purpose for the “5-Star Rating” system was to provide residents and their families with an easy way to assess nursing home quality, and make meaningful distinctions between high and low performing nursing homes.

However, with the onset of healthcare reform and value-based purchasing, a facility’s 5-Star Rating has other ramifications. For example, in order to participate in CJR, a facility must have maintained a 3-Star Rating or better for 7 out of the last 12 months. Likewise, a facility’s Star Rating will likely have a significant impact on being included in ACO partnerships and bundled payment initiatives. While earning a 4 or 5 Star Rating has always been a nice advantage, the 5-Star Rating may likely effect a facility’s ability to survive in today’s era of health care reform!

The “5-Star Rating System” is based on three objective assessments:
  • The facility’s three most recent health inspections;
  • Measures based on appropriate staffing levels;
  • As of July 1, 2016, sixteen different Quality Measures, or “QMs” that reflect clinical outcomes for both Short-Stay and Long-Stay residents.
More About Quality Measures: Test Your QM IQ
Up until now, CMS assessed all Quality Measures (listed below) based on a facility’s self-reported clinical data via MDS assessments for long-stay and short-stay residents:

Long-Stay Measures for percent of residents with:
  • Increased need for help with ADLS
  • Pressure ulcers
  • Physical restraints
  • Urinary tract infections
  • Moderate to severe pain
  • One or more falls with major injury
  • Antipsychotic medication use
Short-Stay Measures for percent of residents with:
  • Ulcers that are new or worsened
  • Moderate to severe pain
  • Antipsychotic medication use
As of July 2016, two important changes will take place: (1) CMS will take into account five additional Quality Measures, and (2) in some instances, QM performance will be based on Medicare billing (rather than only the MDS assessments). This has important implications because facility staff must understand coding nuances to avoid mistakes that could result in poor QM ratings and subsequently low 5-Star Ratings. For example, as with coding for UTI, pressure ulcers, and falls with fractures, these areas specifically have detailed criteria outlined in the RAI manual and could lead to incorrect scoring if not followed exactly.

The new Quality Measures to be added include one more Long-Stay measure for percent of residents whose ability to move worsened and four Short-Stay measures for percent of residents:
  • Needing rehospitalization
  • Needing an ER visit
  • Returning to home
  • Who had improved function
The “Roadmap” for Improving/Maintaining an Optimal 5-Star Rating
HealthPRO®/Heritage views these changes in the 5-Star Rating System as a “roadmap” for how to best satisfy CMS-defined requisites AND boost quality of patient care. Our approach has focused on designing and implementing robust, therapy-driven clinical programs and initiatives which directly align with the criteria reflected in CMS’s Quality Measures. By linking these evidence-based practices with the expectations defined in each of the 16 QMs, our customers become more strategic and intentional in how they can drive their Star Rating. The results of this direct approach have been overwhelmingly positive; with stronger evidence-based programming and the proper tools in place, facilities are able to better track and report out on improved quality of care that serves to directly impact Star Ratings.

Clinical programs and assessment tools should be implemented to specifically address each of the 16 Quality Measures. For example, HealthPRO®/Heritage works to customize clinical strategies for each of the following five QMs with associated clinical solutions. These examples should serve to demonstrate a straightforward approach to linking CMS’s expectations with executing on clinical resources.

To manage ulcers/wounds
  • HealthPRO/Heritage's sophisticated "Wound Care Program" with most up-to-date, evidence-based treatment protocols
  • Experts in wound care on staff
  • Use of "PUSH Tool"
  • Support to capture appropriate billing
To address UTI
  • HealthPRO/Heritage's own "Incontinence Program"
  • HealthPRO®/Heritage leads an interdisciplinary approach to ensure UTI symptoms are tracked
  • Support to appropriately capture/code so as to ensure appropriate billing
To mitigate unnecessary Rehospitalization
  • Because the most common reason for rehospitalization is medication-related, HealthPRO/Heritage offers comprehensive medicaiton management training forresidents
  • Training / Implementation of "MedMaide" (Medication Management Instrument for Deficiencies in the Elderly)
Falls
  • "Defying Gravity" is HealthPRO/Heritage's proprietary program; it offers sophisticated training for all staff on issues related to mitigating risk of falls.
  • Tools to assess balance, fall risk, etc. are used to capture, track and manage
Pain
  • Advanced manual therapy techniques
  • State-of-the-art modalities
  • Robust pain assesssment tools
  • Interdisciplinary strategies, as with coordinating with nursing on timing of medication
Five More Tips for a Five Star Rating
HealthPRO®/Heritage remains dedicated to executing on unique strategies that will continue to support key success drivers that impact Star Ratings. For example:

1) HealthPRO®/Heritage recommends knowing details related to your current 5-Star Rating and how your facility is being benchmarked against peers. This information is readily available (as with a subscription to Avalere) and should be a critical piece of the puzzle for any strategic plan.

2) Now that some QMs will be based on Medicare billing, accuracy of how these interventions are coded is more important than ever. For example, HealthPRO®/Heritage recommends a clean, triple check process that may require interdepartmental collaboration and consultation with the facility’s EMR vendor. Additionally, staff training and revision in QA procedures may be necessary.

3) Leverage/share information about strategies in place so as to build credibility and establish the perception of meeting the expectations of what a “preferred partner” and/or “high quality care center” can offer a cross continuum partnership.

4) The importance of a well-coordinated, interdisciplinary approach is the foundation on which a facility can build a better Star Rating. Nursing and rehab teams must work together to ensure care redesign strategies take hold and to avoid duplication of services. Shared assessment tools and standards of care must be aligned, as well as skilled documentation practices (especially in the referral process) are also important.

5) It is perhaps unconventional for a therapy management firm to claim they can help improve their clients’ 5 Star Rating. On the contrary, HealthPRO®/Heritage is committed to helping our post-acute care operators to deliberately optimize their 5 Star Rating, one Quality Measure at a time!

Think outside the box and engage with HealthPRO®/Heritage to strategize on how to enhance your own 5-Star Rating. Contact us today Read More

Tags: Heritage Healthcare, HealthPro, CMS, 5-Star Rating, Advisor

Get Your Seat At The Table Today!

Posted on: April 11, 2016



The Time is Now to Execute on Initiatives to Optimize Patient Care & Demonstrate Positive Outcomes


Accountable Care Organization (ACO) networks and bundled payment programs continue to gain momentum across the nation. As such, these influential networks (inclusive of physician groups, hospital systems, managed care, etc.) are becoming more influential and even more refined.

Every post-acute care (PAC) provider must be considering strategies to link elbows with referral sources, ACO/bundled payment networks, managed care networks and regional conveners. After all, the climate has changed quickly and dramatically; consider the startling statistics:
  • Currently, one in ten Medicare beneficiaries are attributed to an ACO
  • 50% of all payments this year will be via a value-based program
  • 90% of FFS MCA dollars are linked to quality or value

The impact of these health care reform mandates speak volumes! They suggest that this shift will continue to gain momentum. For example, several studies demonstrate the percentage of bundled payment patients discharged from the hospital setting directly to a skilled nursing facility has dropped as much as 30% - 50% for orthopedic and cardiac valve replacement surgeries.

High Expectations!
Becoming part of a preferred network or bundled payment program is critical to PAC providers’ survival, but it comes with a price: high expectations!

Healthcare organizations and networks are seeking only strategic partnerships that will help them to remain financially viable. As such, it is imperative for PAC operators to not only understand these expectations, but to also execute on processes, programs and plans in support of these important strategic changes as soon as possible. The following discussion encourages swift and smart execution on three critical drivers: quality patient care, monitored performance metrics and tactical operational changes.

Patient Care is Paramount
CMS’s focus on the “Triple Aim” initiative dictates whether many PAC facilities will survive the healthcare reform transition. There is a universal sense of urgency related to adopting internal care designs to improve quality patient care and satisfaction; improve the health of populations; and to reduce the per capita cost of health care. Additionally, the “Six Aims for Improvement” defines “ideal healthcare delivery,” and PAC providers must also be prepared to demonstrate their efforts to align with each of the six quality indicators, which state that care should always be:

  • Timely
  • Efficient Equitable
  • Safe
  • Effective
  • Patient-Centered
Moreover, “in-network” providers are expected to embrace INTERACT, or a similar program to track, manage and report out on a comprehensive admission, discharge planning and communication processes related to care transitions. Often times, although a PAC operator understands the value of INTERACT, implementation is a challenge. Execution on developing care paths, advanced care planning tools, patient/caregiver education, quality review and QAPI processes continue to be intimidating but worth the investment.

The Power of Performance Data
The key to unlocking strategic partnerships is the ability to demonstrate positive performance data. In fact, ACO networks and those who own bundled payment programs will require preferred PAC providers to report out on bi-weekly/monthly/quarterly reports on performance metrics and key outcome measures to designated Clinical Care Coordinators. At the minimum, a PAC operator should have systems in place to swiftly and easily demonstrate:
  • Functional outcome measures
  • Care coordination measures
  • Patient engagement measures
  • Organizational capability measures
  • Composite measures
  • Efficiency measures
  • Disparity measures
  • Performance Measures
Moreover, each provider ideally should also implement the use of internal scorecards to capture the following:
  • Re-hospitalization rates by diagnosis;
  • Percent of patients discharged home/ with home care / with out-patient referrals
  • Average length of stay by diagnosis for both SNF & HH partner
  • Quality Measures- sepsis/UTI, falls, cognition, etc.
  • 5-Star Ratings
  • Therapy intensity (minutes/week)
  • Functional Status Changes/LOS
  • Control group/peer benchmarking/ hospital & national standards
  • Cost/episode by diagnostic group

PAC providers can also leverage the power of performance data related to marketplace intelligence and data analytics specific to their referral sources. For example, it’s important to understand how a referring hospital’s reimbursement and their cost is associated with readmissions, VBP adjustments and/or Avoidable Hospital Days. Consider the value of a savvy PAC operator who is able to identify and strategically execute on interventions that contribute to the mitigation of unnecessary costs for their referral source; a “Win-Win” result in this scenario would surely hard-wire an important network partnership.

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Tags: Heritage Healthcare, HealthPro, post acute care provider, PAC provider, Advisor Newsletter, Advisor

HealthPRO Named One of Northeast Ohio’s Best Places to Work for Fourth Time

Posted on: September 23, 2015

Northeast Ohio – HealthPRO® Rehabilitation is proud to announce its recognition by ERC as one of the 2015 NorthCoast 99 Award winners. This prestigious award honors 99 great workplaces for top talent in Northeast Ohio. The award was established to recognize organizations and their ability to build and maintain great workplaces that support the attraction, retention, and motivation of top performers. Companies are assessed in a variety of areas such as staffing & workforce, development & training, compensation & rewards, success & performance, and organizational culture & innovation.

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Tags: therapy services, Contract Rehab, HealthPro, NorthCoast 99, Northeast Ohio

May is Better Hearing & Speech Month

Posted on: May 1, 2015

Thank you - SLPs!

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Tags: Contract Rehab, HealthPro, Speech-Language Pathologists, Long Term Care

April is Occupational Therapy Month

Posted on: March 26, 2015

Thank You – OTs and COTAs!

This month, HealthPRO® Rehabilitation celebrates what you do to help individuals live life to its fullest. Our customers, their residents, and your company appreciate what you do every day.

“Occupational therapists and occupational therapy assistants help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations).” -- American Occupational Therapy Association

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Tags: Contract Rehab Services, Contract Rehab, HealthPro, Nursing Homes, Healthcare Reform Expertise, OT MOnth

SNF PEPPER Q4FY14

Posted on: February 20, 2015

On or around April 20, 2015 CMS contractor TMF Health Quality Institute will release the third annual Program for Evaluating Payment Patterns Electronic Report (PEPPER) for SNFs—a resource characterized by both its unrivaled offering of free, comparative billing data and mediocre utilization by nursing home providers.

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Tags: nursing home operations, Contract Rehab Services, therapy services, Contract Rehab, HealthPro, Nursing Homes, CMS

5 Star Quality Rating System Changes from CMS

Posted on: February 19, 2015

Nursing Home Compare 3.0: Revisions to the Nursing Home Compare 5-Star Quality Rating System

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Tags: nursing home operations, nursing home occupancy, Contract Rehab Services, skilled nursing facility, medicare, therapy services, Contract Rehab, HealthPro, census development