CaringForward

Revised "Coming to Your Census" eBook now available

We have just published an updated version of our "Coming to Your Census" eBook. If you thought eight steps to marketing more effectively and building quality census were great, wait until you see the nine steps in the revised version! OK, actually, there's much more updated than that. You can download the new eBook for free here: http://www.patientplacement.com/legacy/landing/ComingToYourCensus_eBook_9Steps100611.html 

The revised eBook identifies nine marketing and census building strategies that deliver proven results for skilled nursing facilities:

• Acknowledge census management, marketing and sales as critical operational processes
• Start at the end – establish your reporting and analysis requirements
• Prepare for, don’t panic about, reimbursement cuts
• Feel the need for speed in your referral response times
• Take marketing to task – assign, track and measure marketing activities
• Buy your liaisons mobile Internet devices today
• Don’t settle for good enough—it’s neither good, nor enough
• Embrace Web-based solutions
• Find a partner, not just a vendor

 

Early Returns on the ACO Final Rule by CMS: Cautious Optimism

The CMS released the final rule on ACOs yesterday. So far the industry response has been largely positive, if a little guarded as people sort through the details. Most are giving CMS high marks for thoroughly considering the 1,300 or so comments submitted in response to the draft rule. Here's a breakdown of some of the coverage:

From post-acute and long-term care:

• McKnight's praises CMS for easing initial requirements and timelines for providers to participate, as well as for sweetening the incentives under the shared savings program.
• Long-Term Living Magazine also reports the news as positive, closing with this conditionally supportive statement from the AHCA: “We support the concepts of ACOs and their intended purpose, and certainly want to ensure skilled nursing and post-acute facilities are part of the cost-saving model. We’ll be examining the details in the coming days and weeks to ensure our sector can play an important role moving forward.”
• And Patrick Connole from Provider Magazine provides additional details, noting that the final rule reduces the number of quality measures from 65 to 33 and eliminates the electronic health records requirement. 

Other perspectives:

• Cheryl Clark from HealthLeaders Media posts an extensive summary and analysis, again with largely positive initial reactions from several sectors of healthcare. Clark does note one negative response from prominent provider alliance Premier Inc. related to beneficiaries being able to participate without sharing data. Even so, Premier's complete response to the final rule praises much more than it criticizes. 
• Healthcare IT News focuses its coverage on the lifting of the much-maligned EHR requirement, which in the draft rule called for “50 percent of primary care physicians [to] be defined as meaningful users by start of second performance year.” The final rule has makes it “no longer a condition of participation.” The article goes on to quotes that the final rule “retained EHR as a quality measure but weighted higher than any other measure for quality-scoring purposes.” Some had cited the initial requirement as being too nebulous and onerous to allow ACOs to get off the ground.

 See the complete, 696-page final rule here. 

Shoddy "Study" Falsely Incriminates SNFs for Too Many Medicaid Hospital Readmissions

We are usually fans of McKnight's, but they dropped the ball reporting on a dubious recent study indicating that Medicaid beneficiaries are 27 percent more likely than private pay residents to be sent to a hospital rather than treated on site. 

The article reports without question the conclusions of the study's authors that it's all about the money—they say skilled nursing facilities are quick to send Medicaid patients back to the hospital because reimbursements don't cover costs.

The study, at least as reported here, overlooks two face-slappingly obvious variables:

• It looked at hospitalization data from skilled nursing facilities in only one state, New York.
• It does not address other characteristics of Medicaid patients that might increase their liklihood of hospitalization.

The authors take a specious and disingenuous leap based on these limited findings and conclude that all SNFs consider financial incentives above clinical considerations when hospitalizing patients. The study methodology and data may be acceptable and accurate, but none of it supports the broad conclusions the researchers make.

Online articles like this from industry publishers don't typically get many comments, but this one raised some ire among SNF professionals:

• "Quite honestly, I am sick to death of defending LTC. We work hard and provide great care and services to all of our residents regardless of their payor types."
• "I have been in LTC for 25+ years and have never heard such bull. Nursing facilities take very good care of our LTC residents. Maybe it was the State they surveyed with the problem and yet we are all lumped together as a whole. This is not a true picture of the quality care we give our residents."
• "I think they are way off base on this one. We work very hard to think first, 'What is the hospital going to do for them that we can't?' and if we can't answer that question, we keep them here."

Commenters also noted the role the primary care physician plays in determining whether the patient needs to go back to the hospital:

• "First let's get it straight that nursing homes don't just send residents to the hospital.  There is a process in which a doctor is involved and they tell the nursing home to send the resident...short of emergencies."

Others questioned the study's validity:

• "People who have Medicaid as their payor go to the hospital more often, but correlation does not imply causation. The cause could be because privately paying elders are often healthier (and younger). Jumping to the conclusion that the cause is financial--at least from this article--is headline grabbing, but premature."

We've posted about this before, how agencies or groups with other self interests to promote distort research in ways that create an atmosphere of fear and frustration for the people who operate nursing homes and devote their lives to compassionate care. It's just another frustrating example of groups taking easy shots at a beleagured segment of the healthcare community, without really examining root causes or solutions.