An Entirely New Paradigm for Post-Acute Health Care Management
The managers of residential care facilities we work with everyday report that the residential care and post-acute health care industry is changing at an alarming rate. The Center for Medicare and Medicaid Services has shifted its focus away from simply measuring volume, toward a pay-for-performance system focused on value and quality. The implications of this shift in payment processing and compliance procedures for management in post-acute care, nursing homes, and hospice facilities are vast, complex, and daunting. Managers are scrambling to measure quality outcomes, improve compliance, and emphasize the customer experience throughout their organizations.
They say that an entirely new industry has emerged from the United States Congress and the minds at CMS. Procedures for record keeping and seeking reimbursement have been completely redesigned to gather and report a whole new data set.Listed below are only a few examples of the new documentation required.
CARE
Starting with the Medicare Post-Acute Care Payment Reform Demonstration, the CARE (Continuity Assessment Record and Evaluation Item Set) tool was created to standardize assessment items based on current scientific literature. These assessments are related to patient severity, payment, and quality-of-care monitoring.
PEPPER
Skilled Nursing Facilities must now download the 2015 Program for Evaluating Payment Patterns Electronic Report (PEPPER). This report is designed to help SNFs understand where they stand in relation to other SNFs in their state and nationally with regards to vulnerability for investigation for improper Medicare payments.
STAR RATINGS
In February 2015, by Presidential order, a staffing component consisting of an overall rating for the entire nursing staff was added to the star rating system. New quality measures dealing with the use of antipsychotic medications were also added. Both these new measurements could impact a facility’s rating by as much as two stars, and these two performance components now need to be tracked and evaluated by management.
BUNDLED PAYMENTS
The Affordable Care Act has specified that a three year study be conducted to evaluate the efficacy of care models that link payments for multiple services that a beneficiary receives during an episode of care. This new initiative includes a provider-led redesign and re-engineering of care pathways that will result in standardized operating protocols, improved care transitions and coordination.
IMPACT
In January 2015, CMS initiated the Improving Medicare Post-Acute Care Transformation Act (IMPACT) to improve the reliability of the data gathered through nationwide survey inspections, payroll-based staffing reporting, the scoring methodology, and additional quality measures.
The intention of CMS is to improve the quality of care and to re-purpose the payment system. However, this new initiative, however well-intentioned, is asking residential care managers, "to explore strange new worlds, to seek out new life and new civilizations, to boldly go where no man has gone before".
Perhaps it will help if you name your office Starship Enterprise and see yourself each morning as striking off on a bold new adventure.
As a result - we will be launching our newest FAMCare EHR module in the first half of 2016. Stay tuned for more details.
