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Date ArticleType
8/1/2016 Regulatory
Lowdown with Lori: The New Currency - Hospitalization Rates

The Days of "Muffin Marketing" Are Over!
The New Currency - Hospitalization Rates

The days are long gone of presenting your staff with a platter of cookies in order to get through a difficult project or offering a tray of muffins to discharge planners at the local hospital to build relationships. Data marketing now replaces "muffin marketing," and data must be presented to gain a competitive advantage because cuts are coming to skilled providers with high or unimproved hospitalization rates. So the time is NOW to position yourself to avoid penalties and achieve business success!  

The skilled nursing reimbursement system has and will continue to evolve.  If you want to be a successful contender, or frankly, even be invited to the table for future business, you must have a profile that attracts payers, hospitals, customers and employees.  The profile of a skilled nursing provider must include evidence based outcomes showing cost containment, value, and quality consistently throughout the organization.  I would be remiss not to mention the importance of staffing levels with the right employees having enhanced skills to match the residents' clinical needs. In addition, it is imperative to have a customer service and hospitality response program 24 hours a day, 7 days a week, 365 days of the year that is both proactive and efficient in customer response. The bottom line is both internal and external customers must have an exceptional experience and the data to prove your competency.

In reading the article entitled “Leveraging Data Can Help Accelerate Change” in Provider Magazine, it states one should be aware that the Centers for Medicare and Medicaid Service (CMS) currently use the Minimum Data Set (MDS) submissions to calculate every provider’s hospital readmission rate. The data is collected and takes months to publish and then providers are a day late and a dollar short in responding to needed improvements.  Our skilled nursing centers need census because it keeps us in business.  It’s clear to me, just taking care of people isn’t good enough anymore.  We need to take care of people at a lower cost, have outstanding quality and service, prevent unnecessary hospitalizations, and be able to prove our ability to do it. I agree with the article that in order to do this well, we must track live data for our facility and our competitors and understand the data. To read the full article, click here.

It’s no secret, all CMS Payment, Regulatory and Reporting programs have hospitalization rates as their central focus.  Let’s review the reasons hospitalization rates should be a primary focus of your daily operations and part of your Quality Assurance Performance Improvement(QAPI) Program.

• Hospitals have 3% of their Part A payments linked to re-hospitalizations.
• Hospitals, ACO’s and MA plans use Skilled Nursing Facility (SNF) re-hospitalizations rates to establish Skilled Nursing Facility Post-Acute Care (PAC) networks and referrals.
• SNFs will have 2% of their Part A payments linked to re-hospitalizations.
• Five star added re-hospitalization rates to Quality Measures.
• Proposed changes to SNF Requirements of Participation emphasize practices to reduce re-hospitalizations.  

The SNF Value Based Payment was passed in 2014, and it is also important to know that the Protecting Access to Medicare Act (PAMA) links SNF Medicare Part A payments for the next 10 years. This can and will affect your bottom line if your facility is not performing well.  A payment adjustment of up to a 2% cut in SNF Part A rates each year (fiscal year) based on a Skilled Nursing Facility re-hospitalization score will occur.  A re-hospitalization rate is defined as the better of a SNFs achievement score or improvement score.  The statute specifies the calculation will start with an all cause readmission measure (SNF RM) and transition to a potentially preventable readmission measure (SNF PPR).  The Centers for Medicare and Medicaid Readmission Measure includes only Medicare FFS Part A beneficiaries that are admitted to the skilled facility within 1 calendar day from hospital discharge.  The Re-Hospitalization Score, as mentioned before is the better of your achievement or improvement score.  The Achievement Score (0-100 points) based on a calendar year and the first year is CY 2017.  The Improvement Score (0 to 90 points) will be based on a SNFs improvement over a two-year period with the first improvement comparing calendar year 2015 to calendar year 2017.

The Low Down is this: If you think you have until 2017 to improve your hospitalization rate, you are sadly wrong. Behind the eight ball. Already delinquent in making improvements. In short, and to cut to the chase, the clock is already ticking, and your time to impact achieved hospitalization rates was yesterday. Fortunately, there is still time and always will be time to improve, and as I mentioned earlier, you will receive credit for improvement.

Strategies to Reduce Hospitalization Rates
The first rule is to use what is already out there.  Don’t reinvent the wheel; just perfect it! 

“Workaholics aren’t heroes. They don’t save the day; they use it up.  The real hero is already home because they figured out a faster, better way to get things done.”
- Janson Friend & David Heinemeier Hansson

A revolving door of resident move-ins with acute transfers to the hospital can improve with a systems thinking and Interdisciplinary approach.  Decreasing fragmented care across the health care delivery continuum is a wining solution for everyone.  I would like to draw your attention to some of the resources that already exist in order for you to achieve improvement to your hospitalization rates. 

LTC Trend Tracker
As I mentioned earlier, making the most of your currency and how to implement strategies to safely reduce hospital readmissions is a must, in order to avoid negative financial outcomes.  Keeping your eye on the target by tracking and monitoring your hospitalization data is imperative.  You can utilize AHCA/NCAL’s LTC Trend Tracker and all the resources available thru your IHCA/INCAL membership.  LTC Trend Tracker is a web-based tool that gives your facility local, regional, and national data.  There is power in knowing information about yourself and your competitors, as well as, having benchmarks for comparison, right at your fingertips.  Using the dash board to quickly see how you compare to others with hospitalization rates can help you gain a competitive edge.  The AHCA/NCAL has broadened its Quality Initiative to assist you in improving your nursing home care.   Read about the eight critical areas you need to meet with measurable targets by 2018 here.  The areas listed are aligned with Centers for Medicare and Medicaid Services.  For information on how to access LTC Trend Tracker, contact ldavenport@ihca.org.

Advancing Excellence
If you set a goal to prevent your residents from the risks associated with transfers to the hospital when an acute condition can be managed at your facility, then Advancing Excellence (AE) is another great resource.  Short introduction videos can be viewed to help get you started, as well as, an organized instruction sheet with tips on how to get started.  Click here to view the video and other resources. I would like to mention that the AE Hospitalization Tracking tool allows live time tracking.  It also has a nice feature, once data is entered and aggregated, that displays data graphically with different views making analysis of the data easier.  The important key to success is knowing where you are, where your competitors are, and where you need to be in relationship to hospitalization rates.  To review the Leadership Fact Sheet on Safely Reducing Hospitalizations click here.

INTERACT
Adopting the INTERACT program is another strategy that has been proven to work.  The program forces a facility to view all admissions as preventable, especially visits to the emergency department resulting in an immediate return to the skilled nursing facility.   The effectiveness of adopting the entire INTERACT program is proven to be successful but the most important key is to let the goals drive the implementation.  It uses a preventative approach, by managing conditions in the skilled nursing facility without transfer but only when it is safe.  Utilizing the advanced care planning and palliative care tools can also result in improved hospitalization rates.  The INTERACT resources can assist your already stressed workforce with early identification of changes of resident condition thru assessment, and streamline communication and documentation to increase prompt intervention and decrease transfers to the hospital.  I will stress again, most success has been with facilities adopting a systems approach to safe hospitalization rate reduction by utilizing all of the program instead of a pick and choose some of the program approach. Click here to review INTERACT Resources.

Hospitalization rates are everyone’s business, and it takes a combination of commitment, communication, coordination from the top down in order to do the "right things" for residents for the right reason.  A continuous systems approach to your performance goals will accelerate the positive outcomes for your facility.  It takes the village to stay on track and gain the competitive edge with hospitalization rates. 

“Continuous improvement is better than delayed perfection.”
-Mark Twain

If you have questions or need assistance with your Quality Assurance Performance Improvement (QAPI) Program implementation or reduction of hospitalization rates, contact Lori Davenport, Director of Regulatory Clinical Affairs at ldavenport@ihca.org.