As the healthcare industry continues its shift away from fee-for-service models toward value-based reimbursement, hospitals and health systems are focusing on selling outcomes rather than procedures.
During a Feb. 20 webinar sponsored by the healthcare interventional analytics provider Real Time Medical Systems and hosted by Becker's Hospital Review, Phyllis Wojtusik, Real Time Medical Systems' executive vice president of hospital system solutions, and Shane Dearing, the company's executive vice president of business development, discussed changes to post-acute care reimbursement and strategies to develop successful partnerships to improve hospital readmission rates and outcomes.
Post-acute care providers include skilled nursing facilities, home health agencies, long-term care hospitals and inpatient rehabilitation facilities, with SNFs and HHAs providing most of these services. Strong partnerships with post-acute providers are key in improving overall readmission rates and outcomes for hospitals, according to Mr. Dearing.
Changing reimbursements incentivizing care collaboration
The Improving Medicare Post-Acute Care Transformation Act (IMPACT Act) of 2014 was designed to improve the delivery and reporting of Medicare's post-acute care services. The legislation established a quality reporting program for post-acute facilities to submit standardized data.
The IMPACT Act improved coordination efforts and streamlined and standardized data sharing across all post-acute lines of business, while an additional rule in 2019 required quality measures to be included upon discharge planning with SNF discharges, according to Mr. Dearing.
In addition, IMPACT's patient driven payment model, which took effect October 2019, switched SNF Medicare payments from volume to value, enabling post-acute facilities to focus on outcomes-based reimbursement. "This presents an incredible opportunity for us to capitalize on SNFs, increasing emphasis on the care model and outcomes of their patients," Mr. Dearing said.
The change in reimbursement incentivizes SNFs to deliver care that not only benefits hospitals upstream but also offers direct financial benefits on the post-acute side, according to Mr. Dearing. An increase in Medicare Advantage plans has allowed SNFs to focus on the most capitated rates to get patients out of their facilities and manage length of stay.
With shared savings top of mind, SNFs are more likely to be willing to adapt to standards and models of care set by new strategic partners. "We believe that driving toward value-based partnerships is going to be the key motivation to driving savings in this space," Mr. Dearing said.
Developing successful post-acute partnerships
When building a successful post-acute care network, it's vital that each partner shares the same vision. Post-acute partnerships should be built on open communication with specific goals and result metrics outlined, so all parties are on the same page, according to Ms. Wojtusik.
"Most people can relate to what's the right thing to do for the patient because that's what drives care, cost and outcomes," Ms. Wojtusik said. "If you set the right tone with your vision up front, then the health system and post-acute partners — whether they're SNF or home-based — really has to follow because it's the right thing to do for the patient."
Standards drive positive outcomes, and to ensure facilities provide care in the same ways that hospitals do, clinical standards in post-acute settings should be based on national standards, such as those set by the American Medical Directors Association and the Interact Quality Improvement Program.
For integrated care delivery models to become successful, post-acute care must serve as an extension of the care patients receive at the hospital. Hospitals must be able to monitor patients in post-acute care centers the same way they monitor patients at their own facility.
"Focus on process driving care, not just the outcome," Ms. Wojtusik said. "You can't unilaterally build metrics. You need to understand other levels of care and what their metrics are and include those metrics in your overall outcome. One of the most important things is honest communication."
Keys to managing post-acute networks
Establishing regular meetings to engage with post-acute partners is important to assess these facilities' performance on the previously outlined results metrics. Building metrics-driven discussions and engaging in routine readmission meetings helps identify why readmissions occurred, when they occurred and how they can be reduced.
Connecting with post-acute providers to understand their challenges will help identify ways they can be assisted and determine if results metrics need to be altered based on the care they're able to provide.
"If you don't check in on your relationships you don't know how it's going," Ms. Wojtusik said. "If you don't listen [to the providers] they will become frustrated and disengaged and you're not driving toward the financial and quality outcomes that you really want."
In this era of value-based care, partnering with the right post-acute care providers should be top of mind for hospitals. Rewarding facilities that achieve high reductions in readmission rates or improve process with increased referrals and endorsing them with a seal of approval has been shown to enhance care and improve outcomes.
"It not only drives that patient's outcome; it drives your outcomes," Ms. Wojtusik said. "People vie for those types of results, not only because they want to do it for the patient but because they want to be highlighted in the network as a really good partner. Keeping those vision and goals in front of you and rewarding for outcomes really drives engagement at the facility level."
Conclusion
Changing reimbursement structures and an anticipated rise in Medicare patients discharged to post-acute care facilities presents a significant opportunity for hospitals to forge strategic partnerships and drive improvements in care. Implementing clinical standards, setting specific results metrics and regularly connecting with post-acute partners will ultimately lead to improved care in these settings, boosting hospital and health system readmission rates and overall outcomes.
To learn more about Real Time Medical Systems click here, and view the full webinar here.