If you’re not monitoring length of stay and cost of care data from your post-acute providers, you could be jeopardizing your hospital’s bottom line when pay-for-performance initiatives kick in.
“If case managers transition patients to a facility that readmits a lot of patients or keeps patients longer than expected, that will increase the Medicare Spending Per Beneficiary metrics and increase the cost of care in bundled payment arrangements,” says Beverly Cunningham, RN, MS, consultant and partner at Oklahoma-based Case Management Concepts.
Case managers have to track the length of stay their patients have with post-acute providers and partner with those who provide the most efficient and cost-effective care, she adds.
Check out the scores of the providers to which you refer on Nursing Home Compare and Home Health Compare websites, she suggests.
Start by looking at the performance of any home health agencies or skilled nursing facilities that are part of your health system. If they don’t provide the same level of care as other facilities or they have a higher readmission rate, work with them to make changes, Cunningham suggests.
In the past, skilled nursing facilities were paid on the basis of how many patients they had, Cunningham says. “Now, they are having to adjust to payment based on value. Case managers should work with the facilities in their area to help their leaders understand the importance of providing the most efficient and high-quality care,” she says.
Medicare Conditions of Participation require that patients have a choice of post-acute providers, but case managers should let patients know which provider has the best quality scores, Cunningham says. One way is to include the CMS Star Ratings for each provider on your lists of home care agencies and skilled nursing facilities.
When DCH Health System in Tuscaloosa, AL, analyzed data from its skilled nursing facility partners, it found that some of the facilities they frequently referred patients to actually had the highest costs, according to Carolyn Hamilton, MS, RN-BC, CDDS, CPHQ, corporate director of case management for the three-hospital system.
Instead of giving patients lists of post-acute providers in alphabetical order, the health system ranks the facilities according to their performance on quality data. (For more information, see related article in this issue.)
DCH is working with its post-acute providers, particularly the skilled nursing facilities, to focus on keeping costs down. “Since the hospital has accountability for what happens in these facilities, we may need to influence treatment,” she says.
The Improving Medicare Post-Acute Care Transformation (IMPACT) Act requires post-acute providers to measure and report quality metrics, Hamilton points out. “This is a huge opportunity for hospitals to work with post-acute providers and help them improve the quality of care they deliver,” she says.