Recent CMS initiatives have created an interesting dynamic in the post-acute care industry: Providers across the care continuum are being incentivized to form strategic partnerships and hold each other accountable for delivering efficient, enhanced patient care.
Although it’s a challenge to both choose (and be!) a valuable partner, providers from skilled nursing facilities (SNFs), Senior Living (SL) & home health agencies (HHAs) must form these upstream and downstream alliances by focusing on what matters: objective clinical/performance outcomes and CMS’s fiscal incentives/penalties.
To illustrate, consider Senior Living operators who worry about the financial implications and the impact on overall care and satisfaction when residents experience a functional decline or are hospitalized. A SL community that partners directly with a sophisticated home health agency (with proven clinical expertise and demonstrable performance outcomes) can proactively help residents avoid exacerbations, manage chronic conditions and avoid unnecessary hospitalizations or emergency room visits. Well-trained therapists from high-quality HHAs assess early/subtle changes in a resident’s condition to keep them safe and healthy and support residents as they age in place or transition between levels of care. (Likewise, SL communities that offer Medicare Part B/out-patient therapy can also help maintain occupancy and support a vibrant culture for residents living their best life.)
Skilled nursing providers are also motivated to partner with the right HHAs -- but in response to a very different incentive: SNFs will be looking to take advantage of CMS’ up to 2% incentive for lowering 30-day hospital readmission rates (and/or avoid being penalized up to 2% of the Medicare Fee For Service Payments.) Like their Senior Living counterparts, SNFs will look to partner with home health providers who proactively manage rehospitalization risk, are able to serve a higher acuity population, and will actively support the option for at-risk residents to return to the SNF setting for non-critical conditions versus returning to the hospital.
Already under pressure to reduce emergency room visits, mitigate hospital readmissions, grow/maintain STAR ratings and OASIS functional scoring, HHAs are facing a dramatic change in reimbursement as of January 1, 2020 with the launch of PDGM (Patient Driven Groupings Model). As such, HHAs must focus on strategies to assure positive outcomes and leverage innovative clinical programming/resources. After all, the post-acute care world is watching; home health performance measures are publicly available here.
To be considered a “good” partner, members of any alliance, or network must be willing to proactively:
- Assure clinicians are practicing at the top of their license, utilizing best practices, and participating in continuing education to enhance ability to care for medically complex patients and to identify patients at risk for hospital readmission.
- Set the bar high with cross-functional innovative programming (such as HealthPRO Heritage’s Safe Transitions) and schedule clinical collaboration meetings to develop discharge, admission, and readmission strategic protocols or policies (including care conferences and metric/outcome reviews). Coordinate transitions processes, operations and define customer services standards (e.g.: follow-up protocols, etc.)
- Create and share scorecards that highlight outcomes, showcase successes and illuminate opportunities to enhance patient care and program performance
- Leverage strong partnerships by creating cross-referral processes. This may be especially important for HHAs that will be reimbursed at a higher level for Institutional Referrals (rather than Community Referrals).
- Facilitate communication between those involved in patient care (e.g.: IDT caregivers & family). Offer cross-functional educational resources before, during, and after discharge.
Reap the Benefits of a Cross-Continuum Alliance
As with any partnership, there are clear benefits to both sides if successfully cultivated. All providers are seeking a workable approach that allows them to improve both clinical outcomes and financial performance in care delivery to patients. Through collaboration, overall patient outcomes and satisfaction will improve while delivering care with greater fiscal opportunity under CMS’s initiatives of Value-Based Purchasing (VBP), PDPM, and PDGM.
HealthPRO Heritage is dedicated to providing innovative solutions – including the facilitation of strategic partnerships --via Consulting and Therapy Management services for a diversified client base that spans the post-acute care continuum. Three robust service sectors – Clinical Strategies, Senior Living, and Home Health– provide a unique industry perspective and compliment the core Therapy Services Division to enhance revenue, redesign care and support our clients as they transition through Medicare payment reform. Contact us at email@example.com with comments or inquire about our services.