How SNFs Can Overcome Medicare Advantage Challenges and Embrace a Value-Based Care Mindset

There are often instances when a skilled nursing facility (SNF) receives patients who are covered by a Medicare Advantage (MA) plan and face more time-consuming challenges than admitting patients with traditional Medicare. It can frequently become laborious for the SNF caregiving staff to gather data in order to determine appropriate care and length of stay (LOS). For example, PT/OT may be ordered upon admission to the SNF, but it is possible the patient also needs additional services such as Speech Therapy or a special bed may be needed to properly care for a patient receiving treatment for wound care. Delay in obtaining prior authorization from the MA plan for additional services and/or equipment can further impact morbidity and extend LOS. Additionally, making updates to the MA plan may be required every 3-4 days to weekly; preparing data to support the appropriate level of care and receive appropriate reimbursement can be a time-consuming requirement.

The Vital Role SNFs Play in the Rising Medicare Advantage Plans

Although no two patients are alike, they may share a common admission diagnosis. The more current, active comorbidities a patient has, the additional care and time may be needed at the SNF. A longer SNF stay may ultimately be, the better, and less costly decision for clinically complex patients. A thorough analysis is a significantly better option than a hospital readmission after the patient has been discharged from the hospital and ultimately returns to the SNF prematurely.

The SNF setting, a component of post-acute care (PAC), is one of the highest cost sectors in healthcare. Hospitals and health systems are building preferred networks not only with SNFs, but with assisted living facilities and home health agencies to both advance clinical performance and generate savings. Pay-for-performance MA plans continue to evolve, prompting SNFs to intervene in order to deliver higher quality care and improve patient outcomes for levels of reimbursement. This can often be considerably less than with the Patient Driven Payment Model. SNF providers who embrace a value-based care (VBC) mindset could potentially earn more MA referrals and the reimbursement that comes with it.

Year to date, payers offer more than 3,800 MA plans, supporting a projected 9% increase in enrollment over the previous year. Many traditional Medicare beneficiaries currently enrolled in Parts A and B are expected to join MA plans (Medicare Part C) in 2023. As MA plans grow, it becomes necessary for SNFs to demonstrate that they are efficiently and effectively managing patient outcomes, both clinically and financially, to MA payers.

Currently, few PAC providers participate directly in VBC programs, particularly those featuring risk/reward payment models. However, real success in VBC – measured by improved outcomes and lower total cost of care – is achieved with the active participation of each segment of the healthcare continuum, and that includes SNFs.

Succeeding in Value-Based Care with Live Post-Acute Analytics

Real Time Medical Systems (Real Time) equips SNFs with live, actionable data and post-acute analytics to help them to intervene and improve the quality of patient care and ensure appropriate reimbursement – the core tenets of VBC.

Real Time’s Resident Dashboard provides direct line-of-sight into the care being provided and identifies additional attention which may be necessary. Through Real Time’s clinical alerts, readmission risk scoring tool and suggested interventions, SNFs can help prevent hospitalizations and ER visits by intervening in the patients care earlier before an adverse event occurs. With Real Time’s timely reports, driven by live data found in the post-acute electronic health record, SNFs are informed about where they stand today in meeting or exceeding quality metrics. Currently, most SNFs wait for an extended time for data, lagging indicators from MDS, or claims data to identify improvement opportunities. With Real Time, SNFs have actionable insights at their fingertips to inform clinical decisions. They can reassess care plans, make process changes, manage workflows, and reinforce training to correct less than optimal performance.

Using Real Time’s timesaving, Interventional Analytics solution, SNFs can best communicate with MA plans and reduce the total cost of care. They may even share in earned savings by breaking the cycle of hospitalizations and ER visits, decreasing LOS, and improving other clinical quality outcomes. With a clear strategy for managing risk, backed by live post-acute analytics, SNFs can establish themselves as essential providers in the value-based payment system and be reimbursed appropriately.

ABOUT THE AUTHOR

Christine (Chris) Gerace Johnson, MPA, NHA, PA-C, works both clinically and administratively in the post-acute care sector for more than 30 years. Chris is an experienced healthcare leader whose value-based focus and energetic training skills have served as a source of knowledge and inspiration for many healthcare providers. With expertise in compliance, MIPS, EHRs, operations, process development and implementation, Medicare, Managed Care, PDPM, analytics, and more, Chris is able to simplify complex topics and communicate them in an informative, meaningful, and useful way to her audience.