CMS has been pushing acute providers to connect the continuum for several years. Now that multiple CMS programs include claims-based measures that track patients outside of skilled nursing facilities—the Value-Based Purchasing, SNF QRP (Quality Reporting Program), and Five-Star programs—it’s clear that post-acute providers are expected to start monitoring patients across care settings as well. Because this is a new concept for most SNFs, it’s no surprise that performance on claims-based measures is markedly worse than on traditional minimum data set (MDS)-based measures. The inherent lag time in the calculation of claims-based measures only compounds the problem. How can a SNF provider proactively respond to a patient event if they’re not even aware it happened until months later? Much like the acute industry, the SNF industry is now recognizing that real-time patient data is a critical ingredient for success in today’s CMS programs. With real-time data, SNFs can manage their patients and resources more effectively, improve care transitions while reducing hospital readmissions, and showcase their value to referral partners.
Many SNFs operate on thin margins and have finite resources, so it is imperative that their staffs have a way to flag high-risk patients who require more complex care (e.g., patients with a lack of mobility, who take certain medications, or who require special treatments) as soon as they enter the building. One way to get this real-time information is through ADT (admissions, discharge, and transfer) feeds. At CarePort, we’ve developed an ADT model that stratifies patients by risk using ICD-10 diagnosis codes that are included in these data feeds.
Because they are reliant on outdated claims data, post-acute providers are struggling with CMS programs that hold them responsible for patients after they are discharged. A prime example is the SNF Value-Based Purchasing Program, which ties up to 2% of a provider’s Medicare fee-for-service reimbursement to a claims-based readmission measure. The skilled nursing facility readmission measure (SNFRM) has a measurement window that extends beyond a patient’s SNF stay. Based on the most recently reported performance data, 75% of SNFs took a pay cut. In fact, from 2015 to 2017, the industry performed worse on this measure.
To improve on the SNFRM and similar measures, SNFs need a consistent view into patient activity post-discharge—as events are unfolding. With real-time alerts, if SNFs see a pattern of patients being readmitted to the hospital shortly after their stays, for example, they can seek out the root cause of the issue with that care transition and address it. Perhaps patients are being discharged too early or perhaps their discharge plans are inadequate. Either way, the first step toward resolving the issue and avoiding future penalties is to become aware of it.
Post-acute care accounts for 10% of all Medicare spending, so acute providers participating in bundled payment programs, ACOs, and other value-based arrangements are now building preferred post-acute provider networks to manage this end of the continuum. To gain access to these networks, SNFs need to be able to share a comprehensive quality story.
Being limited to the quality measures that are available in the public domain can put SNFs at a disadvantage. Measures that are reported on a smaller lag time because they are calculated from the MDS fail to capture important outcomes outside of the SNF setting. On the other hand, measures that are based on claims data are too old to represent a facility’s quality with accuracy. When it comes to joining a network, what’s truly valuable is the ability to drill down and calculate quality measures by condition (e.g., by COPD, congestive heart failure, or joint replacement) or even specifically for patients from a certain referral partner.
The need for real-time data in health care is universal, but it is particularly pressing for post-acute providers, who are now joining their hospital and health system peers in being held responsible for patient outcomes.