4 Reasons Data is King for SNFs

The release of the Patient-Driven Payment Model (PDPM) in October 2019 reshaped the operating landscape for Skilled Nursing Facilities (SNF). Changes have continued to be made to the PDPM annually in response to increased costs, the COVID-19 pandemic, value-based care models, and general industry evolutions. For example, in 2023, CMS implemented a two-year parity adjustment period. In 2023 and 2024, each category would have a 2.3% reduction in case mix indices. There was also a 4% increase equal to $1.4 billion in Medicare Part A payments to SNFs.

These new regulatory changes also come with opportunities to leverage data to drive results. The Quality Reporting Program penalizes facilities for missing information or incomplete data, highlighting the need for accuracy to monitor trends, track outcomes, and identify patient service gaps.

By identifying areas where data can be best employed and closely following the updated data collection and monitoring regulations, managers, owners, and operators can make better decisions, improve margins, and position their teams for success in the next phase of the industry.

1.      Continued Improvement in Efficiency of Care

The biggest overarching change in PDPM is a shift from volume-based care to value-based care. While this should be an overall win for the industry, it does put some added pressure on SNFs to continue improving care efficiency. We are seeing the need for greater efficiency and streamlined operations than ever before amid this leaner system.

Data is the lifeblood of efficiency. SNF care teams can only get stronger when they track metrics like treatment success rates, supply and resource usage, average length of stay by condition, readmittance rates, intake assessment successes, alternative treatment success rates, and other treatment-related data points. MDS 3.0 data is the basis of the case mix for facilities. While some of these metrics are new, they support the need for data-driven patient care. Areas where calculations would be useful include:

• Cognitive level
• Eating
• Hygiene
• Mobility
• Comorbidities
• Depression and behavior symptoms

Data on what’s working and what’s not drives more informed decision-making, better patient care, and a more successful operation overall. It focuses on each patient’s needs and conditions rather than a facility-wide goal for the volume of services. Because of the variable per diem through PDPM, as a patient’s needs change, the reimbursement rate also reflects their current needs. Providers will need to use calculation worksheets for SNFs provided by the CMS to track the appropriate measures and reevaluate each patient’s needs as their condition changes.

2.      Saving Through Resource Management

In resource management, data has proven extremely effective in improving efficiencies. By tracking how a facility employs staff, equipment, outside contractors, and all available resources, it can begin to identify areas of success and areas for improvement.

Chances are your operations already run lean, but with the recent changes to reimbursement, every penny and every second counts. A few dollars of savings or a few minutes of extra time might seem small, but when extrapolated over hundreds or thousands of patients over the year—it adds up. CSM estimated that skilled nursing facilities would save $2 billion in aggregated costs over ten years. That’s $12,000 and 183 hours in annual savings per provider.

One of the largest reasons for these savings is focusing on the patient’s clinical characteristics rather than the number of therapy minutes received. SNFs will be rewarded for treating patients with more complex needs and reducing readmission rates. This means that efficient and effective treatment is the highest priority. Per diem reimbursement tapers, the longer the patient receives care, the more efficiently the therapy is delivered, and the faster the patient can return home, creating an incentive for the patient and the provider to make space for more intensive patient care.

Strategically utilizing technology, rehab therapy, interdisciplinary teams, and patient assessment will support providers as they determine the right level of patient care for each individual. This will, in turn, help to use resources intelligently and develop tailored treatment plans to create the biggest patient benefit in the shortest amount of time.

3.      Identifying Trends in MDS Assessments

The already important MDS intake assessment becomes even more critical to success under PDPM, as the results can dictate patient stay reimbursement. Step one is training MDS coordinators and assessors on the new changes and what to look for. This is more important now that so many updates have been made to the MDS assessment process in 2023 and 2024.

MDS assessments must be completed upon admission, periodically throughout a patient’s stay at the SNF, and before discharge. One benefit of having this standardized data is the quality monitoring of the facility. There are measures for long-term and short-term patients to monitor rates like re-hospitalizations, changes in skin integrity, infections, emergency department visits, and other facility-wide metrics. Identifying negative trends is the first step to correcting gaps in treatment.

Step two is using data to support your direct service staff. By tracking and assessing patients throughout their stay, we can identify any trends of conditions, comorbidities, or Section GG items that could be included during the assessment. The changes and new responsibilities are already a lot to put on intake staff. By tracking and comparing intake assessments with what treatment staff and contract therapists are seeing, SNFs can identify areas where they can adjust supportive training.

The new and expanded MDS assessment will involve everyone at the facility providing resident care. With this multidisciplinary approach, teams can learn from one another, and administrators can easily use machine learning technologies to identify areas where additional training will be helpful. This could include professional development, adding technologies that streamline processes, or extra support for achieving MDS goals.

4.      Protection from Audits and Takebacks

Under the old system, SNFs only needed to defend the volume of therapy in the case of audits and potential takebacks. While you know may know the measures you, your team, and your contractors take in order to treat patients, but you may be required to show it in greater detail. Keeping detailed data and treatment records becomes key to manage these situations. By utilizing systems and best practices to document treatment efficiently and effectively, audits and takebacks become no big deal.

The structure developed for the use of the assessment data is as follows:

1. Assessment using the MDS
2. Decision-making and creating a Care Area Assessment
3. Care plan development by the appropriate professional for that area of concern (dietician, physical therapist, physician, specialist, etc.)
4. Care plan implementation in any of the 20 care areas detailed by MDS assessments
5. Evaluation is required every three months or when there is a major change in health status to keep data current and reimbursement appropriate

MDS data is sent to CMS and shared with the public via the Five-Star rating system for SNFs. The facility is responsible for data accuracy and can be held accountable for incorrect coding. CMS can claim overpayment due to inaccurate coding, missing documentation, or administrative errors for takeback.

In June 2023, CMS started an auditing process based on the belief that skilled nursing facilities did not adequately understand and change in response to the 2019 PDPM updates. They implemented a five-claim review, looking at five claims from each SNF to provide one-on-one provider education where more accurate coding is needed in the future. If your facility is affected by this auditing process, expect additional resources to share with MDS nurses, who will be held to higher standards.

Data Analytics Becomes an Essential Skill

Because of all the data collected, coded, and shared through the MDS assessment process, facilities and CMS will be able to monitor and track a wide variety of metrics that are essential to patient care and correct reimbursement. Technology trained on machine learning and big data sets will be essential to process the information collected and pull out related strands of performance metrics.

Technology has become increasingly essential to keeping pace with changes in the healthcare industry and proving that an SNF provides effective patient treatments. Accurate data will empower views of the industry as a whole, pinpointing areas where residents are not improving and facilities that are not correctly trained on the newest requirements. It will also enable the administration to drill down into smaller sets of patients, diagnoses, treatments, and providers for information about their rates of comorbidity, readmission, or billing errors.

Electronic Health Records are the gold standard in health care when it comes to visibility and data monitoring. The best systems include alerts to prevent coding errors, AI-generated suggestions for treatment based on thousands of other medical records, and simple integrations to collaborate with a patient’s entire healthcare team easily. Data is the key to helping SNFs function smoothly and navigate audits, and these tools make tracking it much simpler.