White Papers

PDPM is arguably the biggest policy change in the health care industry in the last 20 years with numerous strategic and operational implications.

In our new e-book, you will learn:

  • Implications for health systems and post-acute care of Medicare’s finalization of the Pathways for Success overhaul of Medicare’s ACO program and critical decisions that bundlers made in the first quarter of 2019.
  • Importance of post-acute care in creating value within these payment reforms; and what steps can lead to more integrated care.
  • What you should consider in preparing for the implementation of PDPM, from both a strategic and an operational perspective.
  • This white paper will give you tangible takeaways and action steps to help position your organization for success as you implement this new policy.

Health Dimensions Group (HDG) is a leading consulting and management firm, providing services to post-acute, long-term care, and senior living providers as well as hospitals and health systems across the nation. Serving the industry for more than 20 years, HDG’s focus is on the aging services continuum. Every year, HDG identifies the top trends affecting the future of senior care. In 2019, the trends that will radically shape aging services include Medicare fee-for-service payment reform, value-based payment, occupancy challenges, swift action by investors, ongoing workforce issues, complex network development, managed care growth, improved psychosocial management, senior asset repurposing, rural health innovation, and aggressive cash management.

As operators and consultants in post-acute, long-term care, and senior living, Health Dimensions Group (HDG) is familiar with the challenges and opportunities facing health care organizations in the coming year.

HDG has identified nine trends in 2018 that will continue to radically transform senior care, including evolving ownership models, value-based payment growth, labor shortages, occupancy and demand fluctuations, regulatory pressures, senior living medicalization, and partnership expansion.

It’s a tough market right now for senior housing. The National Investment Center for Seniors Housing & Care (NIC) second quarter 2017 senior housing data release shows that occupancy fell 50 base points and assisted living occupancy is at its lowest rates since 2009. However, respondents to the 2017 NREI/NIC Senior Housing Market Study still favor senior housing over other types of commercial real estate investments. Almost half believe the industry is in a recovery and expansion stage while believing new competing properties are the number one threat to occupancy—above the U.S. economy or housing market. In the end, this means that investors will continue to invest and build in senior housing, further increasing the occupancy pressures of all providers.

Now is the time for senior housing providers to implement and embrace sales fundamentals in order to reach or maintain their goal occupancy levels. Following are some observations on potential pitfalls that senior living providers make in their sales approach that adversely affect their occupancy success.

What Doesn’t Change with a New Administration and Health Care? The Rise of (and Responding to) Consumerism in Health Care. President Trump and the Republicans, leading both the House and Senate, vowed to repeal and replace Obamacare and the Affordable Care At. Earlier this month, the House Republicans made good on the promise and introduced repeal and replace legislation, The American Health Care Act. There continues to be speculation on what a final plan will look like, one thing that is not the subject of much speculation-the emergence of consumerism.

This movement results from myriad changes to health care payment and delivery and additional provider options, combined with consumers’ increased education and heightened involvement in their own health care. All these market factors necessitate consumer-driven strategies, which are a cornerstone of success for hospitals and health systems in this new era of empowered consumers. This paper highlights the reasons for the continual rise of health care consumerism as well as strategies to respond to this trend in your hospital or health system, specifically in area of senior services, as seniors are the largest consumers of health care in the United States.

Palliative care is not a newly introduced approach to care. The earliest record of the Latin word palliate, meaning to conceal or alleviate symptoms without curing, dates to the 14th century. Formally introduced in 1990 by the World Health Organization, palliative care is currently defined as an approach to care which improves quality of life for patients and their families facing advanced life-threatening illness through prevention, assessment, and treatment of pain and other physical, psychological, and spiritual problems.

In 2011, the Joint Commission launched the Advanced Certification for Palliative Care program, which recognizes hospital inpatient programs demonstrating exceptional patient and family-centered care to optimize the quality of life for adult and pediatric patients with serious and advanced illness. By 2014, palliative care had grown to over 1,500 inpatient programs nationally. Currently, more than 85 percent of hospitals with 300 or more beds have a palliative care program, 90 percent of teaching hospitals have palliative services, and 90 percent of National Cancer Institute (NCI) Designated Cancer Centers have palliative care, while 78 percent of non-NCI cancer centers have palliative care available.

The increased focus on improvement in the quality and delivery of health care, balanced with the goal of reduction in health care spending, requires providers to develop and execute operational strategies that result in the optimization of operational and financial performance. This optimization is not only crucial to providers, but for partners and payors for whom value is also created. Strategies to create and maintain value include revenue drivers such as volume growth, rate optimization, service line expansion, clinical program development and expansion, as well as ancillary payor and external provider partnerships. In addition to these revenue drivers, operational efficiencies for health care cost reduction may include developing new staffing models based on alignment of staffing to acuity, evaluating ancillary service expenses, and creating partnerships with material suppliers.

In what is lightning speed for Centers for Medicare & Medicaid Services (CMS), the July 9, 2015, proposal for mandatory bundling of joint replacement episodes was finalized on November 18, 2015, and went into effect on April 1, 2016.

In recent weeks, CMS also finalized rules for value-based purchasing for physicians and set in motion a nine-state mandatory value-based payment demonstration for home health. Medicare is continuing to push transformative policies with respect to alternative payment models and value-based purchasing.

The implications of these and other changes, such as the growth in accountable care organizations (ACOs) and the Bundled Payments for Care Improvement (BPCI) program, are profound and will be felt very quickly in many markets. Here is an update to our previous white paper on bundling, concentrating on the things that health systems and post-acute providers need to know right now in order to succeed in the new risk-taking environment.