In 2018, skilled nursing facilities will continue to be impacted by outcomes data, both from a regulatory and a business standpoint. Measuring and reporting on outcomes is important because it will enable healthcare organizations to lower costs, improve the patient experience and provide better care.
Much of this movement is being driven by the Centers for Medicare and Medicaid Services (CMS), which continues to focus on outcomes data and value-based metrics to ensure quality care is provided—and minimize the instance of Medicare fraud.
Below are three data-related measures that will impact SNFs in 2018 and beyond. While these don’t directly affect contract therapy providers, SNFs will start asking more of their therapy partners to help them meet these requirements and maintain eligibility.
A value-based purchasing provision within the Protecting Access to Medicare Act (PAMA) of 2014 gives SNFs an opportunity to receive incentive payments based on performance. Starting October 1, 2018, providers will need data to prove that they are reducing hospital readmissions. Failure to do so can result to a 2% loss of their Medicare reimbursements for the year.
The “Mega Rule”
Since October 2016, the Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (also referred to as the mega rule) has mandated changes in the conditions of participation (CoPs) for facilities to improve the quality of care and lower costs. As with other rules, the impact is primarily on the SNF itself. However, there are requirements that impact therapy providers, who will be expected to take a role in ensuring the areas they touch support compliance. The first two phases of the rule’s three-phased approach are in effect. The final phase, set for November 2019, will require SNFs to fully implement all the components of a Quality Assurance and Performance Improvement (QAPI) program, which takes a more systematic, comprehensive and data-driven approach to patient care.
In late October of 2017, CMS Administrator Seema Verma announced the agency’s new initiative for quality measurement titled “Meaningful Measures.” According to Verma, “Meaning Measures involves only assessing those core issues that are most vital to providing quality care and improving patient outcomes.” Currently, no further details have emerged regarding the program. However, Verma stressed the importance of outcomes data as the agency moves from a fee-for-service system to one that pays for value and quality. “The agency aims to focus on outcome-based measures going forward, as opposed to trying to micromanage processes,” she said.
Moving to value-based care means outcomes data—and the ability to measure and track it—will only grow in importance. Through the use of new BI tools, therapy providers will be able to improve patient care with more targeted care plans, while continuing to grow and thrive.
While most EMR software offers some level of reporting, it’s important to ensure that it has advanced capabilities that will allow for the effective analysis, tracking and management of patient populations. For instance, BI capabilities in Optima’s SNF therapy software can help therapy providers identify patients in need of greater care, track patient readmission rates and demonstrate their agency’s value in improving outcomes.
To learn more about outcomes data and other issues impacting therapy providers in 2018, download our Top 2018 Trends for Therapy Providers white paper.