Effective October 1, 2012, CMS implemented a Hospital Readmission Reduction Program designed to provide incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions. CMS defines a readmission in this context as An admission to a hospital within 30 days of a discharge from the same or another hospital. Hospitals include short term inpatient acute care hospitals excluding critical access, psychiatric, rehabilitation, long term care, children’s, and cancer hospitals. This new program will provide an incentive for hospitals to decrease readmissions by coordinating transitions of care and increasing the quality of care provided to Medicare beneficiaries. The program is part of CMS’ goal to transition to value based purchasing; paying for care based on quality and not just quantity.
Currently the program focuses on 3 types of readmissions with plans to increase the number of diagnoses in FY2015 to include COPD and patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Diagnoses subject to penalties currently include, Acute myocardial infarctions, Heart failure and Pneumonia. For FY2013 the penalty is 1%, 2% in FY2014 and 3% in FY2015.
As a SNF provider you may ask yourself, how does this affect me?
Proposed legislation has this same type of program extending to the LTC SNF setting in the very near future. According to a MedPAC recommendation, FY 2017 would mark the beginning of reduced Medicare payment rates for SNFs failing to meet standards for lower readmission rates. Falling short of these standards could cost a given nursing facility up to 3% of Medicare reimbursements. This strategy is very much in line with what is currently aimed at hospitals. Namely, the newly released recommendations call for skilled nursing facilities to work aggressively toward the lowering of readmission rates. The aim is to improve care transitions by:
- Ensuring patients are physically ready for discharge;
- Providing patient families or support systems with education regarding medication management, advance directives, hospice care, etc., and;
- Partnering with high-quality community services to ensure continuity of care
Many hospital systems are actively seeking to create partnerships with SNFs that agree to meet quality standards, share data, provide certain services and work with hospitals to reduce avoidable hospitalizations. Many are using criteria similar to what ACO’s have typically employed when choosing SNF partners. These include:
- Compliance with federal and state regulations
- Meets or exceeds median for federal quality standards
- 30-day hospital readmissions rate at or below national/state norms
- Patient satisfaction ratings at or better than state median
- Patient and family engagement: data and tools
- Attending SNF physicians include primary care physicians and extenders that are part of health system’s physician network
- RNs in the SNF 24/7
- Appropriate nursing hours per patient day for sub-acute care (4.25)
- Average length of stay for Medicare patients at or less than national average
- Discharge at least 60 percent to the community following sub-acute care
- Use of INTERACT II, a set of tools for SNFs to reduce re hospitalizations
- Ability to share information electronically
Hospitals and skilled nursing facilities MUST recognize each other as partners and take tangible steps to become more coordinated. Following hospitalization, many Medicare patients who require daily assistance and medical attention will be discharged to a long-term care facility. It is estimated that 14% of these patients will return to the hospital with conditions that might have been prevented.
Therapy Center has taken significant measures the past 4 years to develop relationships with post-acute care providers, particularly hospitals within the communities we serve . It is our goal to partner with those facilities to educate and implement programs that will create communities where patients receive the care they need and deserve. For more information on Therapy Center’s services offerings, please contact Kristi Fredieu, kfredieu@therapyctr.cbm.codes, 337-384-9791, and visit our website www.therapyctr.cbm.codes.
