News, Skilled Nursing Facility

2017 Resolutions: What to prioritize in the ever-evolving postacute landscape

By Reg Hislop

With a new year upon us and (perhaps) the most amount of free-flowing health policy changes happening or about to happen in decades, it seems appropriate to create some simple resolutions for the year ahead. Similar to the personal resolutions most people make (get healthy, lose weight, clean closets, etc.), the following are about “improvements” in the business/operating environments.

First, a quick overview or framework for where healthcare is and where it is going. A political shift in Washington from one party to another foretells of differences forthcoming. It also tells us that much will not change and what will be is likely less radical than most think. Trump and the Republicans can’t create system upheaval as most of what the industry is facing is begat by policy and law well settled. Similarly, no political figure can change the present economic realities, namely an aging society, a burgeoning public health care/entitlement bill, and the current system, built on a fee-for-service paradigm. In short: where we left 2016 begins the path through 2017 and beyond.

The road ahead has certain new realities. The new realities are about quality, economic efficiency and patient satisfaction/patient focus. The former realities are about fee-for-service, Medicare maximization, and more is better or warranted. The signs of peril and beware for the former is evident via today’s RAC activity and False Claim Act violations pursuit.

Now it’s time to think ahead and make plans for a different 2017:

Resolution 1: Focus on quality, including having a fully integrated QAPI program.

The future is about measurable, discernible quality. No postacute provider, home health or SNF, can survive (much) longer without having 4 or higher Star ratings and a full-blown, operational focus on continuous quality improvement. The deliverable must be open, clear and transparent, visible in quality measures and compliance history.

Resolution 2: Focus on patient preferences in how care is delivered, what patient goals are identified, and consider feedback/satisfaction with service.

The future is about patient preference and satisfaction. For too many decades, patients have gotten detached from what health care providers did and how they (providers) did it. No longer. Compliance and the new Conditions of Participation will require providers to stop paying lip-service to patient centered-care and start now, to deliver it. The new environment is no longer just what the provider thinks the patient wants or should have but WHAT the patient thinks he/she wants and should have.  TIP: Brush-up on the Informed Consent protocols!

Resolution 3: Manage each encounter to make certain that each length of stay is optimal, for the needs of the patient; and that any complication and avoidable issue (falls, infections, care transitions) are minimized.

Efficiency matters going forward. This isn’t about cost. It is about tying quality to cost and to a better outcome that is more economically efficient. The measurement here is multi-faceted. The first facet is utilization oriented meaning length-of-stay matters. The quicker providers can efficiently, effectively and safely move patients from higher cost settings to lower costs settings, is the new yardstick. The second facet is reducing non-necessary or avoidable expenditures such as via Emergency Room transfers and hospitalizations/rehospitalizations. NOTE: This ties back to the first resolution about quality.

Resolution 4: Stop looking at how to expand and maximize each Medicare encounter.

The new world going forward demands that we begin to transition from a fee-for-service mindset to a global payment reality. This transition period will represent some heretical demands. While fee-for-service dies slowly as we know it, its death will include interstitial periods of pay-for-performance aka Value-Based Purchasing. Similarly, and simultaneously, new models such as bundled payments will enter the landscape. Our revenue reality is moving and thus, a whole new set of skills and ideas about revenue capture and management must evolve.

Resolution 5: Create core competencies in advance care planning, care coordination, and the development and implementation of best practice, disease management and care algorithms across common diagnoses and risk areas.

To effectuate any kind of permanent change, new competencies need development. Simultaneous, old habits non-effective or harmful, need abandoning. The new competencies required are care management, care coordination, disease management, and advanced care planning. Reward going forward will require providers to be good at each of these. Each ties to risk management, outcome/quality production, and transition efficiency. Remember, our rewards in the future are tied to efficiency and quality outcomes. Advanced Care Planning for example, covers both. Done well, it minimizes hospitalizations while focusing on moving patients through and across higher cost settings to lower cost settings.

Resolutions 6: Educate yourself and the organization staff. Know how the 5-star system works. Know what value-based purchasing is about. Know the market area your organization is in and how your organization compares from a quality perspective to others. Know your strengths and identify what improvements need to be made.

The world of post-acute is changing. To change or adapt requires knowledge. Too many providers don’t understand the dynamics of the environment and what is shifting, how and when. Opportunity is abundant for those providers and organizations that are up-to-speed, forward thinking, and understand how to use the information available to them.

Reprinted with permission.