Get Ready
Post-Acute to join in the fun of Readmission Penalties
The Affordable Care Act’s mandate
for payment reductions for hospitals with high rates of readmissions is heading
toward the post-acute industry.
The U.S. Department of Health and
Human Services (HHS) 2014 budget proposal includes a Medicare legislative
proposal that could save $371 billion over ten years and smack in the middle of
that proposal is a recommendation that would impose payment reductions to
skilled nursing facilities for preventable hospital readmissions.
Told you so!
HHS references research by the Medicare
Payment Advisory Commission that notes that nearly 14 percent of Medicare patients
that are discharged from a hospital to a post-acute setting – primarily a
skilled nursing facility -- are readmitted to the hospital for what they
consider avoidable care issues. The budget proposal is recommending
that beginning in 2017, payments made to post-acute/skilled nursing facilities
be reduced by 3% for facilities that have high rates of preventable hospital
readmissions.
But it’s not your fault! Right?
Unfortunately that argument is not
going to resonate. Right now, hospitals are tracking
patients they discharge, noting where they are being discharged to and whether
they are being readmitted back to the hospital.
They are literally tracking utilization figures of nursing facilities
because they have to report their rehospitalization rates to Medicare.
It is just a matter of time until
the hospital is going to report to Medicare the names of the skilled nursing
facilities that contribute to high rehospitalization rates, and that is when
it’s going to affect you, the nursing facility.
Medicare will note your rehospitalization rate and penalize you. Thus the 3% reduction begins.
As a skilled nursing facility you
may logically try to explain that the rehospitalizations came as a result of
physician’s orders, non-compliant patients, and so on and so forth. It’s not your fault. But the finger pointing will only get you so
far. The hospital will start to select
facilities that they know can provide quality in-house care to higher acuity
patients, therefore preventing rehospitalizations.
Is your staff trained to reduce
rehospitalization? Can your staff ensure
that the hospital has provided the necessary information regarding the
patient’s plan of care prior to admission? Are they trained to care for the
diseases and conditions most associated with rehospitalizations? And finally,
do they have the skills required to provide the quality care needed to prevent
rehospitalization? If you can’t answer yes to these questions, you may be
looking at a 3% reduction in your bottom line in addition to a lower census
since your hospital partners might just stop referring patients to you.
Check out our Reducing
Rehospitalization Series of courses and our Rapid
Review Series which will provide your staff the knowledge needed to prevent
rehospitalizations so you can say YES to your hospital referral network!
Cheryl Swann RN-BC, BSN, WCC, LNHA
VP of Clinical Services
