Phase Two of The Final Rule goes into effect in seven short months (November 2017), and the post-acute care community must invest time, energy and resources NOW in order to be prepared for the many changes brought on by this recent CMS mandate.Read More
Welcome to the HealthPRO® Heritage Blog
Posted on: May 16, 2017
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
Posted on: April 6, 2017
HealthPRO®/Heritage Announces 2016 Compliance Excellence Achievement Award Winners
Awarded for Commitment to a Culture of Compliance & Our Core Values
Posted on: March 23, 2017
On March 20, HHS issued a statement delaying the effective date of the Final Rule as it applies to three new EPMs. The start date has been changed from July 1, 2017 to October 1, 2017 for:
Posted on: December 20, 2016
This story is a true testament of what we at HealthPRO®/Heritage do.
we heal hearts, minds & spirits.
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.Read More
Posted on: July 27, 2016
Fortify the future of your post-acute care community by understanding how you fit into the “Big Picture” of healthcare reform. Begin with this checklist of five of the most critical factors that will impact your ability to leverage long-term success.
1 - Are You Fostering Relationships with Your Top Three Referral Sources?
While many PAC operators focus only on their #1 referral source, HealthPRO®/Heritage recommends fostering relationships with at least the top three hospitals in your region. Consider how volatile the industry is right now; a sudden, unforeseen merger, acquisition or closing could greatly impact your facilities’ viability.
Also consider: why do your referring hospitals send patients to your facility? Knowing “why” will provide valuable insight into what your facility is doing right! A savvy PAC operator will leverage this perceived strength with other potential referral sources, marketing campaigns, fund development initiatives, etc. Alternatively, if the answer to this question is not quality-related or skill-based, the perception may be that your facility is lacking in some areas. For example, in an ideal scenario, a hospital would site your facility’s exceptional care delivery, smooth admission/transition process, low rehospitalization rates, unique clinical niche programming, etc. as reasons for referring patients.
2 - How Well Do You Know the Dynamics of Healthcare Reform at Play in Your Marketplace?
Are your referring hospitals affiliated with a network or an Accountable Care Organization (ACO)? Are they enrolled in bundled payment initiatives, Medicare Shared Savings Programs (MSSP), Comprehensive Care for Joint Replacement (CJR) initiatives, etc.?
It is vital that PAC operators are aware of what hospital-based dynamics are at play and what value-based purchasing programs are in place. HealthPRO®/Heritage recommends a proactive approach. Hospitals are seeking to partner with quality PAC facilities that can help them achieve their goals. Since these goals are very clearly defined by factors related to healthcare reform mandates and sometimes subtle collaborations/affiliations, the onus is on the PAC operator to be informed and prepared to aggressively establish themselves as trusted allies/partners for the long haul.
If referring hospitals are indeed enrolled in value-based purchasing (VBP) initiatives and/or part of a network, how well are these hospitals performing? Intel related to re-hospitalization penalty status, Hospital-Acquired Condition (HAC) penalties and pay-for-performance initiatives will provide clues as to how you can be a valuable resource/partner for your referring hospitals. Additionally, HealthPRO®/Heritage recommends a careful review of your referring hospitals’ MedPAR data to better understand their challenges and what financial burdens exist; armed with this data, PAC operators can then strategically positon themselves as a solutions-oriented partner.
3 - How is Your Facility Ranked?
Some PAC operators are surprised to learn that every hospital (whether or not they are involved in a network/VPB program) now force-rank every post-acute care facility within their region. These objective rankings are based on performance metrics such as rehospitalization rates, average length of stay and star ratings. Knowing how you rank and compare with competing facilities is a fundamental, critical puzzle piece as you consider your facilities’ future.
Additionally, PAC operators must also be able to identify what other specific factors distinguish their own community and services from competing facilities. Aesthetics, upgrades, renovations as well as clinical niche programs are examples of important features that will set your facility apart from the pack. It’s important to also have a clearly defined, executable plan for leveraging these differentiators, which may require an investment in a “SWOT Analysis” and/or marketing plan.
4 - Have You Vetted Your Home Health Providers?
Since hospitals are force-ranking and selecting only the high-performing post-acute facilities, it makes sense that PAC operators must, in turn, also set criteria for their downstream providers. Important to note: Unfortunately, many PAC operators have an unvetted list of several home health agencies to which they refer. HealthPRO®/Heritage recommends only a “short list” of providers as a quality control measure and to streamline processes that ensure only the best clinical outcomes. In fact, in some scenarios, HealthPRO®/Heritage recommends/facilitates a formal relationship with a preferred home health provider to share resources, set up processes for transitional care and ensure communication.
5 - Do You Know What Factors Contribute to Your 5-Star Rating?
The most recent edition of the HealthPRO®/Heritage Advisor Newsletter ( “Build a Better 5-Star Rating;” June 23, 2016) focused on how PAC operators can put simple initiatives in place (today!) to boost an anemic Star Rating. With each of our customers, HealthPRO®/Heritage encourages a “deep dive” to – first and foremost -- understand exactly why your facility’s Star Rating is what it is.
Also, have you taken into account how the new five Quality Measures (effective July 2016) will impact your 5-Star Rating? While the June 23rd edition of the Advisor Newsletter comprehensively reported out on these CMS updates, we include them again here for easy reference. CMS will now review and evaluate the following: (1) The percent of long-term care residents whose ability to move around has worsened, and the percent of short-term care residents (2) needing rehospitalization, (3) needing an ER visit, (4) returning to home and (5) who demonstrated improved function. HealthPRO®/Heritage consults with customers to put in place specific strategies that address/leverage these new QMs.
For more details related to July 2016 CMS changes and how you can be more strategic and intentional in boosting your Star Rating, please reference the June 2016 Advisor Newsletter, “Build a Better 5-Star Rating.”
BONUS QUESTION: How will changes in your facility’s payer mix impact future financial stability?
Based on HealthPRO®/Heritage data, as many as 97% of PAC operators are citing dramatic changes in payer mix at their facilities. Being able to anticipate and recognize trends unique to your community will be crucial, because payer sources dramatically affect not only reimbursement rates but expectations around minutes of therapy, length of stay, etc. This type of “self-awareness” is necessary for budgeting, staffing and strategic planning initiatives.
HealthPRO®/Heritage has extensive experience working in the post-acute care industry (first, as therapy providers and more recently, as healthcare reform consultants). We recognize how crucial it is for PAC operators to stay abreast of changes and proactively take advantage of opportunities to collaborate and partner with like-minded providers. The ability to leverage these opportunities begins with a foundation of accurate marketplace intelligence and an honest assessment of what you know, and what you don’t know. HealthPRO®/Heritage offers this simple checklist as a foundation on which to build your strategic plan for the future. Our team of industry-leading experts also offers marketplace intelligence, guidance in developing a proactive plan and support in executing on strategic initiatives.
Contact us today! Read More
Posted on: June 22, 2016
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.
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
- Ulcers that are new or worsened
- Moderate to severe pain
- Antipsychotic medication use
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
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
- 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
- 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)
- "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
- Advanced manual therapy techniques
- State-of-the-art modalities
- Robust pain assesssment tools
- Interdisciplinary strategies, as with coordinating with nursing on timing of medication
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
Posted on: May 23, 2016
We can learn important lessons from post-acute care operators who have already made strategic operational and clinical changes in response to health care reform mandates. In many cases, these forward-thinking skilled nursing and rehab communities have been engaged on this path for several months/years, offering the industry a unique opportunity to ask the question: “What have we learned from the first years of health care reform?”
As the industry focuses on the Triple Aim model, there is a recognizable shift in how this “New World Order” is taking shape. For example, HealthPRO®/Heritage considers the following trend significant:
Historically: 52% of ACOs in MSSP did not keep costs below benchmarks in the first performance year.
Today: 1 in 10 Medicare FFS beneficiaries are attributed to an ACO
By 2018: 50% of all payments will be via VBP program; 90% of FFS MCA $ linked to quality or value*
*Source: CMS BPCI Initiative Models 2-4: year 1 Evaluation and Monitoring Annual Report, The Lewin Group, February 2015
It is also interesting to note that within the first CMS evaluation of bundled payment initiatives, there was a 30% reduction in patients admitted to post-acute care setting following orthopedic surgeries. Likewise, in a recent letter to Journal of the American Medical Association (JAMA), New York University’s Model 2 bundled payment program demonstrated a 49% reduction in discharges to PAC providers for cardiac valve replacement surgeries and a 34% reduction for joint replacement surgeries.
Based on these preliminary reports, HealthPRO®/Heritage expects that not only will CMS continue to drive cost-reduction strategies and value-based pricing, but the commercial insurance/managed care industry will also continue to follow suit. As such, hospitals are very motivated to establish preferred partners networks who will help them achieve the following incentives: