Everywhere I turn these days it seems that the topic of reducing hospital readmissions is on everyone's mind. Put aside for a second that this provision is being driven by the Affordable Care Act, the annual cost to Medicare of unplanned re-hospitalizations is in the $17.4 billion range.
Starting in October, the financial impact to hospitals that are not able to effectively manage this issue is going to be significant. Hospitals stand to lose $300 million in 2013 alone, with the retroactive reduction to their Medicare reimbursement rate of up to 1%, followed by 2% in 2014 and 3% in 2015. (American Medical News)
The good news is that I am seeing institutions take this seriously. I see healthcare providers starting to prepare for this change on many fronts. First, some are taking a closer look at the symptoms that span how hospitals manage the discharge process to the role of post-acute facilities in collaborative care models.
So fast forward through the symptoms, and the bottom line for nursing homes and senior care providers is: you are going to be pressed to deliver more of the right care, at the right time, for the right residents. It’s the best way to control labor costs (your largest expense!), staff safely to ensure care, and drive satisfaction. In addition, you must do a better job demonstrating and reporting on your efforts in this area, while facilitating high quality care at low cost. It’s a tall order. To make a significant impact in this area, SNFs should look at incorporating resident acuity into staffing process.
By staffing to acuity I mean applying the case-mix grouping of the resident population to how you schedule and staff, each and every shift. This could mean considering the RUG and ADL score requirements of the residents, which most providers should have already for Medicare billing. But why is staffing to acuity so important?
Most providers today staff to a fixed budget of hours of care per resident, per day (HPPD). This model generally is intended to account for the fluctuations in acuity, across the entire facility. But what happens when Wing A is full of residents that require a lot of care, but Wing B is just as full but the residents there are healthier and require less nursing time? What if the case mix changes and the residents in both wings require an escalated level of care not covered by the fixed labor budget?
A fixed budget distributes the care hours evenly per resident. All residents receive 2.2 hours of CNA care per day, for example, and would not easily allow for a home to accurately balance staffing resources between the highest case mix group and the lowest case mix group, which would require less care time.
When acuity is constantly in flux, how realistic is it to expect a staffing budget based on resident headcount to accommodate the variations in care demands? Without incorporating acuity, a facility can run the risk of underserving residents that require more care which can lead to level of care issues and accidents that require re-hospitalization. Starting in October, when hospitals begin experiencing financial penalties for unnecessary readmissions, this is what they will use to evaluate which post-acute care providers they intend to refer patient to and which they won’t. Nursing homes should be preparing for this quickly approaching reality or risk losing out on a critical revenue stream.
Incorporating resident acuity into the staffing mix will allow a facility to better understand and allocate the right level of care where and when it is required, to better manage resident outcomes and reduce hospital readmissions. For example, acuity based staffing would allow a facility to quickly see that the highest case mix group requires 3.0 HPPD (hours per patient day) of CNA time while the lowest case mix group only requires a .9 HPPD of CNA time. Not only will this better allocate staffing resources, but can bring cost savings from operating with a smaller, more streamlined care team, while delivering the highest quality of care. Hospitals will be looking to develop closer relationships with facilities that prove to be effective in driving positive outcomes and cost efficiencies.
The next step is effectively incorporating acuity into current scheduling practices. Staffing to acuity can be complex. If you have not done so already, this is the best time to say goodbye to pen and paper scheduling. OnShift has just announced a new acuity-based staffing feature called Staff Exact that snaps right on to our employee scheduling software.
To sum it up, incorporating acuity in your staffing practices can go a long way to helping improve outcomes, control costs, and minimize hospital readmission rates. Act now to put the right processes, policies and technology in place to help you improve the delivery of care, create internal efficiencies and realize additional cost savings.
Feel free to share your feedback. Let me know what you’re thinking and what you’d like to see in my blog in the future. I’ll be exploring this topic further in coming posts!
