Reimbursement: Expert Witness Services 

Overview:

The Skilled Nursing Facility Value Based Purchasing (SNFVBP) program rewards skilled nursing facilities with incentive payments for the quality of care that is provided for Medicare beneficiaries.

Section 215 of the Protecting Access to Medicare Act (PAMA) initiated the need for the SNFVBP in order to more effectively communicate performance standards, how facilities can review their scores, and that these scores will be reported to the public. The concept of value-based programs is not a new one, and hospitals and renal clinics have been utilizing value-based programs since 2012. Part of CMS' larger quality strategy to reform how health care is delivered and paid for, value-based programs support the three part aim of CMS, which includes:

  • Better care for individuals:  improve the overall quality of the health care system, by making health care more patient-centered, reliable, accessible, and safe.
  • Better health for populations: improve the health of the population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care
  • Lower cost for care: reduce the cost of quality health care for individuals, families, employers, and government
Beginning in FY2018, the SNF VBP is anticipated to improve patient experience of care by promoting better clinical outcomes during their SNF stay.

The SNFVBP will utilize Quality Measures (QMs) to measure successful clinical outcomes. CMS is focused on paying providers based on the quality, and not quantity of care that they provide patients. Identifying that the population that utilizes SNF care is particularly fragile, CMS seeks to harness the significant and growing purchasing power of Medicare in this sector to provide incentives for improvement in quality of care. Beginning October 1, 2018 CMS will begin to withhold 2% of SNF Medicare payments to fund the incentive payment pool. CMS will redistribute 50-70% of the withheld payments back into the profession by way of incentive payments to SNFs. CMS will retain the remaining 30-50% of the funds as programmatic savings to Medicare. The SNF can partially earn back the 2% withhold based on their rehospitalization rate and improvements.

How can Harmony Healthcare International (HHI) help?

Harmony Healthcare International (HHI) can assist facilities in reducing their rehospitalization rate through analysis of current clinical systems. Facilities must have systems in place that identify clinical risk of the patient, and intervene quickly when the patient is at risk. Harmony Healthcare International (HHI) is available to provide on-site and customized clinical training for the most common reasons for rehospitalization in Long Term Care, including:

  • Early identification of clinical signs/symptoms of systemic infection (septicemia)
  • Respiratory management for at-risk patients, to avoid recurrence of pneumonia, CHF, and COPD exacerbation
  • Clinical practice that will prevent UTIs
  • Care of fragile and renal-compromised patients
  • Avoiding post-operative infections
  • Early identification and intervention for signs/symptoms of delirium
  • Clinical practice to avoid dehydration and malnutrition
  • Falls management and reduction programs