Earlier this week I attended the Wisconsin Director of Nursing Council Symposium and sat through some informative presentations. One in particular quickly caught my attention when the presenter, Daniel Billings from the Pathway Health Services, discussed issues he’s seen facilities experience with ACOs. He has seen several cases where facilities who are not participating have been notified by hospitals that patient referrals will no longer be available to them.
The stark example would be quite painful to many homes where 75% + of residents are referred from hospitals. Not getting hospital referrals could nearly put them out of business overnight. Frankly, with an ACO being an “inclusionary” group simply by its definition, it was only a matter of time before “outsiders” would be singled out and, well, excluded. Post-acute providers run the risk of falling into this category for two reasons: ignorance or compliance. The ignorance problem, believe it or not, should be easier to solve especially with all the proactive communication on ACOs and participation. Compliance, on the other hand, can depend on criteria that have been established for inclusion in the ACO. I can quickly see how commitment to quality, positive outcomes and evidence-based practices will become driving factors of membership in an ACO. Providers with a history of poor outcomes could impact the pay-for-performance, shared benefits and shared risk model of the ACO. ACOs wouldn’t want them because of these risks.
This means that quality, tracking of quality and reporting of quality are now more important than ever. To be successful, SNFs will have to be more aggressive and proactive about making sure they are being included in the ACO. They must make sure the effective processes and results they have achieved are prominently on display to all involved parties.
The importance of EHR is more than just a clinical documentation system, but an enabling force for the ACO to prevent negative outcomes and document reduction of preventable rehospitalizations. ACOs will expect to see from SNFs new initiatives around EHR like a comprehensive rehospitalization prevention program.
Just this morning I read an article in The Washington Post on Health law’s rules help hospitals cut patient readmission rate which stated that “the nationwide rate of hospital readmissions of Medicare patients within 30 days of discharge declined to about 17.8 percent.” This is being directly attributed to the hospital penalties in President Obama’s health care law. That’s coupled with “extra funding and incentives for hospitals and outpatient providers to do a better job of coordinating care for patients after they head home”. Expect to start seeing more processes and systems that connect hospitals and providers with the goal of achieving better outcomes in order to achieve their financial goals. The new mantra may be: care, document, share, repeat (CDSR).
My next blog post will cover how efforts cannot stop at EHR. Systems and processes that help ensure you have the right staff, at the right time, driving efficiencies and cost savings are critical. After all, your workforce is your biggest asset and directly impacts the quality of care your residents receive. More to come on this topic, as staff scheduling and labor management plays a crucial role in participation in high quality, coordinated care across the continuum.
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