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Ho! Ho! Ho!…Oh No! Readmissions are Not Merry and Bright for Most.

In light of the recent readmission outcomes due to SNF Value-Based Purchasing (SNFVBP), our industry is challenged with some significant readmission penalties.

As you know, The Centers for Medicare and Medicaid Services (CMS) implemented measures to reduce avoidable hospital readmissions by lowering a year’s worth of payments to nearly 11,000 SNF providers. The financial incentives were determined by each facility’s readmission rates.

*The above chart indicates the number of SNFs with SNFVBP Impact: Green-Bonus; Yellow-No Change; Red-Penalty. 

Source: Data.Medicare.gov.

 

Leadership Tips:

Make your Readmission Measure List and Check it Twice…

Consider the following to positively impact your quality processes:

  • Implement INTERACT® – INTERACT® (Interventions to Reduce Acute Care Transfers) is an evidenced-based, internationally recognized quality improvement program specifically designed for post-acute care providers. Identify and implement a comprehensive program for the identification of a change of condition to reduce care transfers. As indicated in the State Operations Manual/Interpretive Guidance, all skilled facilities must have a process in place encompassing all staff to assist in the indemnification and notification of a potential change of condition.
  • Review Your Current Hospitalization Rate – Hospitals, health systems, physicians and insurers continue to review the impact of high readmissions on their Medicare payment rates and will use this information to determine which SNF providers they will choose to as a preferred provider, affecting referrals into SNF organizations.
  • Implement Tracking – SNF providers need to track their overall hospitalization rate on a real-time, ongoing basis for performance improvement and better outcomes. Tracking real-time hospitalization data will provide a benchmark for quality improvement and provide information highlighting your organization’s hospitalization quality improvement efforts as a preferred provider.
  • Understand Your Current Skilled Nursing Facility Readmission Measure (SNFRM) – This is the current measure used by CMS to determine whether you will receive a quality incentive add on to your Medicare rate or a potential penalty, which reduces your Medicare rate for an entire fiscal year.

 

It is important to focus on readmissions now!

  1. Reducing unplanned hospitalizations, including 30-day hospital readmissions and emergency department (ED) visits, are a significant concern for SNFs, as well as acute care hospitals. SNFs are increasingly under pressure by hospitals, health systems and insurers to reduce 30-day readmissions because of the overall impact to the patients and their families, quality outcomes and financial penalties in place for hospitals and SNFs.
  2. Tracking, trending and benchmarking specific quality measures, such as an organization’s hospitalization rate, are fundamental to any quality improvement program.
  3. Unless clearly and consistently defined measures are used, it is not possible to benchmark or compare your measures with other facilities, or with marketplace, state, regional or national data.
  4. CMS is monitoring readmission and ED rates through various quality measurement initiatives, including the SNFVBP and the Nursing Home Compare Five Star short-stay quality measures. These quality measures utilize data sources such as the Minimum Data Set (MDS) and claims data to calculate readmission rates. There will always be a delay to retrieve necessary information from national data sources, which is unavoidable for national programs.

SNFVBP is here to stay! ‘Tis the season to continue to focus on readmission measures for quality and financial success in 2019.

Resources: 

Pathway Health provides the insight, expertise and knowledge to keep your organization on the right path. Visit pathwayhealth.com or 877-777-5463.

 

Author:
Lisa Thomson
Chief Strategy and Marketing Officer
Pathway Health