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From Provider to Consumer
Long-term Care and the Golden Years
I’m very pleased to be here. Let’s face it, at my age I’m very pleased to be anywhere.
----George Burns
Long-term Care
Improving Medicare Post-Acute Care Transformation Act of 2014
IMPACT Act of 2014
Standardization of Post-Acute Care DataAssessment dataPatient dataQuality measuresResource useOther
Source: THE DISTRICT POLICY GROUP
Impact Act of 2014
3 Phases
Phase 1 – PAC providers report dataPhase 2 – Feedback reports from HHSPhase 3 – Public reporting on performance
Source: THE DISTRICT POLICY GROUP
Reporting the Data
MedPAC to recommend a PPS (Prospective Payment)Base payment on patient characteristics rather
than the facilityAccounts for clinical appropriatenessIncorporates assessment dataLooks at integration – motivating greater
coordination on a condition/procedurebetween hospital and PAC
Source: THE DISTRICT POLICY GROUP
Payment Methodology
Access to care and choice of setting Expenditures Facility value
2% penalty
Source: THE DISTRICT POLICY GROUP
MedPAC’s report
Secretary of HHS to do studies:Socioeconomic statusRaceHealth LiteracyLimited English proficiency
Source: THE DISTRICT POLICY GROUP
Improving Payment Accuracy
Declining Average Length of Stay
Higher Acuity
Complex
Patient - difficult to navigate the process
Source: ANNALSOFLONGTERMCARE.COM
Transitioning Patients from Acute to Skilled Care (SNF)
Patient has free choice
A list of available facilities
CMS updated guidelines – provide a more formal and written discharge planning process
CMS Nursing Home Compare website
Source: ANNALSOFLONGTERMCARE.COM
Transitioning Patients from Acute to Skilled Care (SNF)
SNF visit by family
CMS emphasis on early evaluation of discharge needs
Education of care team
Guide family and patientSource: ANNALSOFLONGTERMCARE.COM
Transitioning Patients from Acute to Skilled Care (SNF)
So, if I’m a hospital, I will be able to run a SNF better than those stand-alone facilities?
A. Yes, hospitals know healthcareB. Of course, the acuity is lower in a SNF – no
problemC. No, not necessarily, SNF is a different gameD. A & B
Source: DHGLLP.COM
Acute Care and Skilled Care (SNF)
# of facilities
CMS STAR RATING
* ** *** and above
Hospital owned SNF’s
22 2 9%
4 18% 16 73%
Non-Hospital owned SNF’s
390 7 2%
29 7% 354 91%
Who manages a SNF better? Source: DHGLLP.COM
SNF’s agree and work on:quality standards, data, services avoidable hospitalization.
Banner Health – selected 34 out of 90 Atrius Health – included 35 out of 100 Partners Healthcare – took 47 out of 140
Source: MODERNHEALTHCARE.COM; HHN.MAG.COM
Creating Select Networks
Before:“These are the ones that are close to your house,
pick one of your choosing.”
Now:“These are the ones that we work with and are
trying to reduce readmissions, and we have a relationship with them.”
Source: HHN.MAG.COM
Picking Favorites
Why?
Readmission penalties Capture more of the healthcare dollar Manage population health Reduce cost
Source: HHN.MAG.COM; DHGLLP.COM
Acute Care and Long-term Care Working Together
Shorter length of stay
Hospital readmissions are lower
Source: MODERNHEALTHCARE.COM
Results of the Networks
Post-acute geriatric specialist help acute staff
Respiratory Therapists (LTACH) - help in IP
Wound Care – help OP wound clinic
Source: ADVISORY.COM
What do they actually do?(Use your available resources)
Hospital and SNF physicians – tapering meds
Training SNF staff on managing behavioral patients
Acute medical center partnered with home care group that provided transition guides
Source: ADVISORY.COM
What do they actually do?(Use your available resources)
Acute does not equal Post Acute – get an expert to help you be successful
Read the Impact Act of 2014 – learn the requirements and what to do
Find ways as an acute care system to partner with post acute providers
and increase the value of your health system
Takeaways
I don’t feel old. I don’t feel anything until noon. Then it’s time for my nap.
----Bob Hope
Long-term Care
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