2019 was an exciting year for the care transitions and post-acute care industries. Not only did long awaited rules and regulations go into effect, but the industry as a whole continues to dominate health system priorities as a key area of focus and investment. It’s becoming clear that transitions of care, especially from the acute to post-acute settings, are critical not just for the patient recovery journey but also for success in shifting towards value-based reimbursement models bundle payments and Accountable Care Organizations. While progress has been made, there remains a lot of work to be done. Read below to hear our take on some of the biggest news of the year in this part of healthcare.
- Medicare Discharge Planning Rule
On November 29, 2019 the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) discharge planning rule went into effect. The Conditions of Participation now state that hospitals must assist patients in choosing a post-acute care facility (skilled nursing facility, home health agency, inpatient rehabilitation facility, and long-term acute care hospital) at discharge. The hospital discharge planning process must focus on the patient’s goals of care and treatment preferences. Quality measures and resource use measures must also be used when assisting patients in selecting a PAC provider. The rule change is intended to give patients more information about post-acute care providers when they are making a decision on where to transition to so that they can make more informed decisions. With the continuing shift towards value
- Post-Acute Care Utilization Trends
We have witnessed several trends in post-acute care usage in 2019. We are continuing to see more patients going home, both from the hospital and from post-acute care, despite the average length of hospital stay remaining at about 5.5 days for the past ten or so years. Most interestingly, the type of patient going directly home and using home health and the type of patient entering skilled nursing facilities is changing. Improvements in technology have meant that providers can accomplish more in a short amount of time within a hospital setting, and post-acute care as well as home facilities are also better able to manage health issues. Due to these improvements in health technology, and shifts in reimbursement models, many sick patients who would have previously gone to a skilled nursing facility are going home. Additionally, many of the patients who would have previously been too sick to leave the hospital are being sent to skilled nursing for care. These more complex patients will result in a greater reimbursement under the new payment model, Patient Driven Payment Model (PDPM – more details below). Overall, we are seeing more complex patients entering different settings of care.
- Patient Driven Payment Model (PDPM)
Another one of the major changes in post-acute care in 2019 was the switch from a dropped case-mix classification system (RUGs or RUG-IV) to the Patient Driven Payment Model (PDPM) for skilled nursing reimbursement. This new reimbursement model went into effect in October 2019, and is a more patient driven care model. This model was not intended to change the foundation of skilled nursing, but to make reimbursements mirror the specificities of a patient and their care needs. With PDPM, each payment classification is based on a patient’s unique clinical needs instead of the volume of care provided. Payment accuracy and appropriateness are addressed by classifying patients into payment groups based on specific characteristics. RUG-IV had two case-mix adjustment characteristics, Therapy and Nursing. PDPM has expanded the amount of characteristics by making them more specific: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Non-Therapy Ancillary (NTA), and Nursing. Instead of combining all the factors that go into a patient’s care and reducing it to a classification of a single group, PDPM sees all five characteristics as individual, important factors that better summarize the goals, needs, and characteristics of a patient.This change reflects the continuing move toward a value based care model. For more information about PDPM, check out this article.
- Consumer and Provider Transparency
Increasing consumerism within the healthcare market has led to new measures of transparency, ensuring that primary customers have greater insight to their health choices. One of the biggest post-acute care transparency changes in 2019 is the abuse indicator for skilled nursing facilities on the Nursing Home Compare website, which appears if the facility has been cited for abuse. The CMS put this change into effect on October 23rd, and it is likely to affect how patients select a skilled nursing facility. Additionally, CMS is adjusting how post-acute care quality ratings are calculated and displayed. For example, the quality measure that is related to a patient’s reported experience with pain will be removed from both the Nursing Home Compare website and the Five Star Rating System. Thresholds for quality measure ratings will be updated, and will continue to be updated every six months. To get more in-depth knowledge about the changes in the five-star rating system, you can read this article. With the updated discharge planning regulations, more and more consumers are going to be pushing for transparency and accessing and reviewing this quality data, meaning that it will become increasingly important for providers to manage their quality scores and outcomes.
Throughout 2019 and into the future, Repisodic remains focused on keeping providers up to date on post-acute care news and informing them of how to ensure compliance with new regulations. The Repisodic blog allows you to easily follow any major changes, and understand how they may affect your facility, in addition to what these changes may mean for your patients. Repisodic Choice can help make transitions easier for both patients and providers, as well as help providers navigate trends in post-acute care. Additionally, Repisodic Choice can assist post acute care providers by allowing them to have all of the information about their facility organized in a digestible manner that is easy for patients to access so they can make informed decisions about their care.