Thursday, May 18, 2017

October 1, 2018. Are You Ready?

Lyn Bentley, MSW
AHCA Vice President, Quality & Regulatory Affairs

Hospital readmissions not only have the potential for negative physical, emotional, and psychological impacts on individuals in skilled nursing care, but also cost the Medicare program billions of dollars.

Although significant progress has been made in the safe reduction of 30-day hospital readmissions, more must be done. Preventing these events whenever possible is beneficial to patients and has been identified as an opportunity to reduce overall health care system costs by improving quality. The issue has become a top priority for the Centers for Medicare & Medicaid Services (CMS) and managed care programs.

Starting October 1, 2018, all SNF Medicare Part A rates will be cut by 2 percent to fund an incentive payment pool. At that time, CMS will adjust payments and return some amount to providers based on how well they do in managing their 30-day hospital readmissions by meeting or exceeding performance standards. This CMS effort, the Skilled Nursing Facility (SNF) Value Based Purchasing (VBP) Program, links financial outcomes to quality performance.

So why should providers care about this now if the program does not affect payment until 2018? CMS is currently collecting data that will be used to determine how much centers earn back. Here’s what the agency is reviewing:

  • Readmission performance rates for stays between January 1, 2017 through December 31, 2017; and 
  • Improvement in readmission rates between CY 2015 and 2017. 
AHCA encourages nursing centers to use this time to take action. Providers should know how they are trending and put plans in place to continue to improve their scores by:
  • Tracking quality metrics to understand their performance.
  • Comparing rates to state and national benchmarks to have a better understanding of performance relative to others.
  • Improving performance through implementation of quality improvement programs (e.g., INTERACT).
  • Reviewing confidential feedback quarterly reports using the CMS QIES System.
Visit the website here to learn more about the program and to access tools and resources.

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