The top 5 lessons learned last week included:
1) Skilled Nursing has a very attractive opportunity to step up their game. Dr. Kathleen Griffin shared:
•LTACs: 30 day readmit rate is 10%, current average payment is $38.6K •IRFs: 30 day readmit rate is 7.2%, current average payment is $17K
•SNFs: 30 day readmit rate is 21%, current average payment is $10.2K
•Home health: 30 day readmit rate is 29%, current average payment is $2.6-3.1K
Hmmm. In thinking about those numbers, LTACs and IRFs, with lower readmits, are still pricey options. Home health, while on the cheap, results in an eye-brow raising bounce back rate of nearly one in three. From a SNF perspective: what an opportunity! For those willing to attack readmissions and position quality benefits, there are attractive reasons to partner with them from a hospital’s standpoint given the real value: great care at a great price. Provider Magazine in the February 2012 is packed full of ideas for SNFs to drive down those readmits; the entire issue is well worth a read. Providers are showcased using creative ways to cut readmits in half. With October 1 2012 right around the corner, these innovators will be attractive partners for hospitals looking to protect their revenues.
2) Hospitals have credentialing systems to evaluate providers. John DiCola, EVP of Catholic Health Initiatives, shared his company is “assessing post-acute care capacity and creating a credentialing system, including expectations for quality, cost, and satisfaction (and of course readmissions). Here’s how a partner will be sized up:
•Beds, census, discharge status, LOS •7 and 30 day readmissions
•Functional Independence Measures (FIM) Scores
•Patient and Family Satisfaction •Emergency department visit rates
•Infection rates The wake-up call for post-acute providers: EHRs are no longer optional.
Hospitals will be data-driven animals, and shopping hard for partners with great results to avoid readmissions and protect revenues. Post-acute providers were asked by hospitals, “what value to you bring to the table as a partner?”
3) Transitions of care are key to lowering readmits. Janet Tomcavage of Geisinger Health Plan shared her company’s approach to preventing frequent flyers to the emergency room:
•Call within 24 hours •Focus on three things: meds, meds, and meds
•Ensure services are in place (home care, et al)
•Coordinate a f/u visit with the primary care physician within 3-5 days
•Weekly follow up for 30 days
What struck me was how low-tech, high-touch care is getting results for Geisinger. It’s akin to the nurturing we’d give a loved one in our care; the hospital in this case is standardizing what we do as families into a formal process. The focus on meds is no surprise, given that a recent NEJM study points to 4 meds as the leading cause of over 100,000 re-hospitalizations per year.
4) Elimination of the 3-day acute care stay rule. Both Geisinger in Pennsylvania and Kaiser in California have an intense focus on community based care, wellness, and prevention. Kaiser does not call those under its care ‘patients,’ rather it calls them ‘members.’ Geisinger and Kaiser were successful in negotiating with CMS to get waivers for the 3-day acute care stay need that in turn triggers other Medicare-related benefits like a home care or skilled nursing stay. Applause, applause, applause. Should this be an early indication of big change across the entire healthcare sector – what a grand opportunity for Skilled Nursing to step into the spotlight. Point one above highlights the costs benefits – where skilled is far cheaper than hospital-based post acute care. What a benefit to taxpayers to prevent the expensive hospital stay in the first place.
5) It’s not just a Medicare thing. We heard from Dr. Griffin that “insurers are taking careful watch” of what’s happening with the Medicare pilots across the county, and are “forming into ACOs as aggressively as Medicare players.” No surprises here, everyone is focused on bending the cost curve. We also heard from Terry Carroll of Fairview Health Services, a Pioneer ACO in Minnesota, that his company is “talking to the state regarding bringing Medicaid under the umbrella.” Utah was the first state that I’m aware of to actually pass capitated Medicaid payments into law last March. With the squeeze on state budgets, more are likely to follow should the math look attractive. For industries that have long operated in silos, there is plenty of evidence that markets are shifting where rewards for collaboration will shape the next decade. Those who lower readmissions and have data to prove it; help with care transitions; prove pathways that result in higher quality care; and bring management savvy to the negotiating table – are well positioned to succeed in the accountable world of healthcare that’s arrived at our doorstep.