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Rehospitalization

Jun 08, 2016

How SNFs manage Re-Hospitalization matters NOW!  Steven Littlehale, Chief Clinical Officer for McKnight’s LTC News expounds on the coming impact of rehospitalization penalties and what SNFs need to do to get ready in “What goes around comes around: Time to set up YOUR smart network”.

Littlehale writes, “The PAMA regulation resulted in a promise to withhold 2% of SNF payments in FY 2019 and return a portion of those monies to providers with better rehospitalization outcomes, thus operationalizing the Centers for Medicare & Medicaid Services requirement of value-based payments.

The regulations require CMS to introduce only one rehospitalization quality measure at a time; they will begin with Skilled Nursing Facility Rehospitalization Measure (SNFRM NQF 2510). In the FY 2017 proposed rule they introduced a new measure Skilled Nursing Facility 30-day Potentially Preventable Readmission Measure (SNFPPR).  This new measure is a result of harmonizing the previously proposed SNF penalty (NQF 2510) with the currently in use hospital penalty (NQF 1789).

Now SNF providers will see firsthand the impact of having “too many” rehospitalizations not only within their care, but also anytime in the first 30 days after leaving a hospital, which often includes days post-discharge from the SNF. While these penalty payments won't go into effect until fiscal 2019, it is based upon SNF performance now. In order to establish payment penalties, CMS has to understand past performance of the industry as a whole, determine what it means to be “good”, “better” or “worse” than others, and then measure both SNF performance and improvement over time.

The SNF baseline performance is being established from CY 2015, and CMS will use most of 2016 to calculate SNF performance and improvement models. By no later than August 2017, SNF providers will find out their performance improvement over 2015 baseline rates, and how PPS payments for all of fiscal 2019 will be impacted.”

To learn what Littlehale suggests SNFs should do to prepare read the full article at http://www.mcknights.com/guest-columns/what-goes-around-comes-around-time-to-set-up-your-smart-network/article/497958/

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