As if SNFs haven’t heard enough about the importance of reducing hospital readmissions, there’s another initiative coming down the pike that could cut Medicare reimbursement rates. Behind this most recent regulation is the Value-Based Purchasing Program, the centerpiece of which is the SNF Readmissions Measure (SNFRM). Research shows that SNF executives are already feeling pressure in managing costs and revenues, so these latest changes will only add to the complex balancing act.
David Gifford, MD, MPH, senior vice president of quality and regulatory affairs for the American Health Care Association (AHCA), explained to attendees at the ABILITY Network CONNECT 2016 Quality and User conference in Chicago how the SNFRM works and what SNF providers can do to avoid getting their rates cut under this program.
It won’t be easy for some providers, he noted, but “how much you improve now can help your scores,” Gifford told attendees.
Worth noting is the fact that the measure is an all-cause measure, meaning that any admission directly to a hospital from a SNF will count, regardless of why. The only exception to this is if a resident is not admitted but placed under observation stay status.
In addition, all hospital readmissions will be tracked “within 30 days of discharge from a prior proximal hospitalization.” Part A rates will then be cut (or not) at up to 2 percent for one year, based on a SNF’s rehospitalization score.
CMS will begin tracking SNF rehospitalizations this coming January for one calendar year to determine “achievement” and “improvement scores” for each SNF. Payment withholds will begin in October 2018 and will be based on the better of the two scores.
“Assume all hospital admissions are preventable,” Gifford advised the CONNECT 2016 attendees, noting that avoiding a rate cut means tracking them in real time. Following are some additional tips to help providers stay ahead of the SNFRM pay cut:
- Review all rehospitalizations: It’s important to review each of them and just as important to assume that 100 percent were preventable, Gifford says, especially since the SNFRM is an all-cause measure.
- Use your tools: “If you have a [readmission reduction] tool, use it,” Gifford says. He suggests using an Advancing Excellence tool, which is based on INTERACT.
- Speaking of INTERACT, it does work: As he travels the country, Gifford said he hears people say that the INTERACT program doesn’t work for them. His response: “That’s like saying, ‘I didn’t take the antibiotic and it didn’t work.’ But the INTERACT program works when you implement it properly,” he says. He also admits that while providers will face challenges with components of the program, it’s important to think about what it takes to overcome them.
For example, he suggests that providers take steps to ensure they are using the Stop & Watch and SBAR tools consistently. “The purpose of these tools is to identify people who have early subtle changes in order to prevent them from going to the hospital,” Gifford said.
Gifford also suggests that providers consider who in the building really does know the residents best. In many cases, it could be family members as well as housekeeping staff. These are the individuals who should be completing these forms, he says, noting that “it works really well.” The goal is to identify things that need to be focused on and address them as soon as possible.
- Treat rehospitalizations as triggers to having end-of-life discussions: Since rehospitalizations can be a marker for mortality, Gifford suggests that it’s a good opportunity to ask residents critical questions about the end of life. He offered Atul Guwande’s five questions to explore at the end of life, from his book, Being Mortal:
- What is your understanding of where you are and of your illness?
- What are your fears and worries for the future?
- What are your goals and priorities?
- What outcomes are unacceptable to you? What are you willing to sacrifice and not?
- What would a good day look like?
For more information about the SNF readmissions measure, CMS has published a fact sheet that outlines the top 10 things to know about the measure.