CaringForward

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. 

What Should Your SNFs Target for Medicare Patient Length of Stay?

We've heard from many prospects and industry experts about skilled nursing facilities increasingly seeking shorter stay, high-therapy Medicare patients (see step one in this Long-Term Living Magazine article we previously linked to). One client has told us they are successfully (and dramatically) increasing the number of Medicare or Medicare HMO admissions, while seeing the average length of stay for those patients dip to the sub-20-day range. (How, you might ask? By using our Web-based Referral Management System to automate and accelerate admissions and referral management, and report and understand key referral source and payer trends. End commercial.)

However, we recently heard from another client that bucks this emerging trend toward higher acuity Medicare patients. In reviewing length of stay data, this multi-location SNF COO was encouraged by seeing consistently longer average stays for Medicare, within the 100-day window. Why? He said, with their case mix, his SNFs were being reimbursed at higher rates under the new rules. They realize greater returns, with less cost and effort in new patient acquisition, by managing a longer-term Medicare case mix.

So, I'm curious to hear: What's the average Medicare length of stay at your nursing homes/SNFs today, and what would you like it to be? What are the strategies and trends at your SNFs to best manage quality census and Medicare reimbursements? Have they changed? Are you expanding your rehab and therapy services at your skilled nursing facilities, and does demand for those services continue to grow?

Oct. Provider Magazine Cover Story on Skilled Care Marketing (and We're in It)

This month's Provider Magazine cover story by Patrick Connole is all about marketing for long-term care by best matching patient needs with provider services. It's a good read, covers a lot of territory about the importance of collaboration between hospitals and providers to enable smooth transition from discharge to post-acute care--benefiting patient, provider and hospital. 

Shameless plug: The story includes an inset article highlighting the success Greystone Healthcare Management has achieved in boosting census (5%) and slashing referral response times (73%) at its 26 skilled care facilities with the Web-based Referral Management System. 

And check out the full Provider Magazine cover story on skilled care marketing here.