Description
Insight Article
Understand Current Clinical Pathways
Care today is often very fragmented. Chances are every entity involved
in the episode does things a little bit differently. So which clinical
pathways should your organization use? The answer is quite simple:
use the ones your acute care providers are utilizing. Doing so ensures a
seamless continuum of care, even when patients change settings.
Whether it’s skilled nursing facilities or inpatient rehab, care should
always follow the patient.
When all entities are talking the same language, and the patient learns and recognizes that language and those protocols, care and outcomes seamlessly move right into the home environment. The results of shared clinical pathways include continuity of care, better patient compliance, and a reduction in some of the key metrics important to the acute care provider, such as rehospitalization rates. The most important attribute of protocols is to ensure that all partners in the care process are using the same protocol. Work to achieve that continuity. Build and Sustain Your Rating The current referral pattern will change. Acute providers will begin looking for cream-of-the-crop facilities.
Many post-acute providers will begin to lose out, even from their most reliable referral sources. In addition, the CCJR bundled model contains a key element that goes into effect in 2017. It’s the ability to use a waiver of the threeday qualifying hospital stay for a patient to be transferred to a skilled nursing facility. That facility, however, must rate at least three stars in the CMS Five-Star Quality Rating System.
Therefore, your rating will become even more vital to your competitive position. Consider your rating and strive to improve it so you can be one of those preferred providers that hospitals can choose when they initiate a waiver. Work to earn and maintain your stars. Take Ownership of Discharge Planning Just as hospitals take ownership of the discharge process from hospital to post-acute care, the future calls for your organization to take ownership of the discharge planning from post-acute to the home setting. Again, this is just one more example of the importance of continuum of care. Some of the key metrics that are common are multiple hospitalizations, star ratings, emergency room visits, quality of care (falls and pressure ulcers), and even nursing hours. In addition, look at the geographic regions that are now working under the bundled payment model and align with the post-acute metrics therein.
You can expect those metrics to be precedentsetting. Adopting them means you’ll be ahead of the curve and well positioned when it’s your region’s turn. Consider your quality measures. Be sure your organization is rating well compared to state and national benchmarks.
Work with providers on creating a relevant scorecard. Work…to Design Your Future All of the learning and data coming out of the initial wave of bundled payments is suggesting that skilled nursing facilities are very expensive options for post-acute care. As a result, there’s a tremendous bias for keeping people home and using home health care. Let that motivate you to start working on being more competitive now. Because home care is going to be an increased focus, it’s imperative to become more efficient, know the cost of care, deliver quality, and generate desirable outcomes. About the Author Patricia Boyer, MSM, RN, NHA, Director Patricia Boyer has more than 30 years of professional health industry experience.
Her areas of expertise include long-term care and subacute operations, state and federal compliance programs, and performance improvement process development. She has extensive experience in evaluating facility processes, documentation systems, and developing performance improvement plans to improve efficiency and effectiveness of facility systems. Her recent experience includes conducting RUGs-based Medicare and Medicaid operational assessments in nursing facilities. Pat also authors the monthly Ask the Payment Expert column in McKnights Long-Term Care News. About Wipfli’s Health Care Industry Practice You may not be thinking that this is an important role, but it will be! It’s important not only for the bundled model, but also for the 30-day rehospitalization rule that takes effect for skilled nursing facilities next year.
Why not create those home care relationships now and begin establishing some expectations for tracking and trending the best home health providers? Work on identifying the cream-of-the-crop home health providers and be accountable for discharge planning. Wipfli’s national health care practice has nearly 100 associates dedicated to serving more than 1,800 clients in 46 states, including integrated delivery systems, large community hospitals, critical access and rural hospitals, physician practices, and senior living organizations. Wipfli can advise in all areas of business, from finance and operations to human resources, information technology, and reimbursement. For more information, visit www.wipfli.com/healthcare. Develop Key Performance Metrics If you want to know what to track, measure, and improve, have a dialogue with acute care providers, managed care organizations, local ACOs, and so forth.
Find out what they consider to be most critical. You’ll be able to then track the metrics that are important to the providers that are important to your future success. About Wipfli LLP © Wipfli LLP With associates and offices across the United States, Wipfli ranks among the top accounting and consulting firms in the nation. The firm’s associates have the expertise, skills, and experience to advise in areas from assurance and accounting to tax and consulting services.
For more information, please visit wipfli.com. 2 .
When all entities are talking the same language, and the patient learns and recognizes that language and those protocols, care and outcomes seamlessly move right into the home environment. The results of shared clinical pathways include continuity of care, better patient compliance, and a reduction in some of the key metrics important to the acute care provider, such as rehospitalization rates. The most important attribute of protocols is to ensure that all partners in the care process are using the same protocol. Work to achieve that continuity. Build and Sustain Your Rating The current referral pattern will change. Acute providers will begin looking for cream-of-the-crop facilities.
Many post-acute providers will begin to lose out, even from their most reliable referral sources. In addition, the CCJR bundled model contains a key element that goes into effect in 2017. It’s the ability to use a waiver of the threeday qualifying hospital stay for a patient to be transferred to a skilled nursing facility. That facility, however, must rate at least three stars in the CMS Five-Star Quality Rating System.
Therefore, your rating will become even more vital to your competitive position. Consider your rating and strive to improve it so you can be one of those preferred providers that hospitals can choose when they initiate a waiver. Work to earn and maintain your stars. Take Ownership of Discharge Planning Just as hospitals take ownership of the discharge process from hospital to post-acute care, the future calls for your organization to take ownership of the discharge planning from post-acute to the home setting. Again, this is just one more example of the importance of continuum of care. Some of the key metrics that are common are multiple hospitalizations, star ratings, emergency room visits, quality of care (falls and pressure ulcers), and even nursing hours. In addition, look at the geographic regions that are now working under the bundled payment model and align with the post-acute metrics therein.
You can expect those metrics to be precedentsetting. Adopting them means you’ll be ahead of the curve and well positioned when it’s your region’s turn. Consider your quality measures. Be sure your organization is rating well compared to state and national benchmarks.
Work with providers on creating a relevant scorecard. Work…to Design Your Future All of the learning and data coming out of the initial wave of bundled payments is suggesting that skilled nursing facilities are very expensive options for post-acute care. As a result, there’s a tremendous bias for keeping people home and using home health care. Let that motivate you to start working on being more competitive now. Because home care is going to be an increased focus, it’s imperative to become more efficient, know the cost of care, deliver quality, and generate desirable outcomes. About the Author Patricia Boyer, MSM, RN, NHA, Director Patricia Boyer has more than 30 years of professional health industry experience.
Her areas of expertise include long-term care and subacute operations, state and federal compliance programs, and performance improvement process development. She has extensive experience in evaluating facility processes, documentation systems, and developing performance improvement plans to improve efficiency and effectiveness of facility systems. Her recent experience includes conducting RUGs-based Medicare and Medicaid operational assessments in nursing facilities. Pat also authors the monthly Ask the Payment Expert column in McKnights Long-Term Care News. About Wipfli’s Health Care Industry Practice You may not be thinking that this is an important role, but it will be! It’s important not only for the bundled model, but also for the 30-day rehospitalization rule that takes effect for skilled nursing facilities next year.
Why not create those home care relationships now and begin establishing some expectations for tracking and trending the best home health providers? Work on identifying the cream-of-the-crop home health providers and be accountable for discharge planning. Wipfli’s national health care practice has nearly 100 associates dedicated to serving more than 1,800 clients in 46 states, including integrated delivery systems, large community hospitals, critical access and rural hospitals, physician practices, and senior living organizations. Wipfli can advise in all areas of business, from finance and operations to human resources, information technology, and reimbursement. For more information, visit www.wipfli.com/healthcare. Develop Key Performance Metrics If you want to know what to track, measure, and improve, have a dialogue with acute care providers, managed care organizations, local ACOs, and so forth.
Find out what they consider to be most critical. You’ll be able to then track the metrics that are important to the providers that are important to your future success. About Wipfli LLP © Wipfli LLP With associates and offices across the United States, Wipfli ranks among the top accounting and consulting firms in the nation. The firm’s associates have the expertise, skills, and experience to advise in areas from assurance and accounting to tax and consulting services.
For more information, please visit wipfli.com. 2 .
