Welcome to the HealthPRO® Heritage Blog

When Life Gives You "The Final Rule," Make Lemonade!

Posted on: May 16, 2017

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.

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Tags: Heritage Healthcare, skilled nursing facility, HealthPRO Rehabilitation, post acute care provider, CMS Update 2017, snf, HealthPRO/Heritage, Advisor Newsletter, Advisor, The Final Rule, Comprehensive Care Plane, Post-Acute Care, Care Continuum, Baseline Care Plan

In A Quandary Over Readmission Rates?

Posted on: March 28, 2017



quan·da·ry
(kwon-dree); noun

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Tags: Healthcare Reform Expertise, post acute care provider, Health care reform, 5-Star Rating, Advisor Newsletter, SNFRM, Advisor, readmission rates, SNF value based purchasing program, SNF VBP, SNF 30-day All-Cause Readmission Measure, Quality Measure

Effective Care Transitions: Recipe for Success in 2017

Posted on: February 16, 2017

It’s as easy as 3, 2, 1: 3 Major Tenets + 2 Goals + 1 Process

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Tags: post acute care provider, snf, Post-Acute Care Transformation, Advisor Newsletter, senior living, Advisor, Outpatient, Care Transition, Inpatient, Home Health, successful care transitions, Clinical Strategies, Safe Transitions

2017 SNF Survival Guide

Posted on: January 12, 2017



Major changes are taking place this year for HealthPRO®/Heritage customers! Preparation is key. HealthPRO®/Heritage’s “SNF Survival Guide” outlines two of the most critical CMS actions, and sets the stage for strategic planning and execution on what skilled nursing clients can do to not only survive the battles but to ultimately win the war.

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Tags: CMS, post acute care provider, CMS Update 2017, snf, HealthPRO/Heritage, value based purchasing program, post acute, LTC provider, snf survival guide, vbn program, all cause readmission rates, SNFRM, LTC, 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