Managing Your Post-Acute Spend – The Cost of Doing Nothing

During a recent webinar hosted by the National Association of ACOs (NAACOS), Real Time’s Executive Vice President of Health Systems Solutions Phyllis Wojtusik, RN, and Vice President of Clinical and Network Quality  Margie Latrella, MSN, APN-C discussed the clinical and financial impact of Accountable Care Organizations (ACOs) “doing nothing” when it comes to post-acute spend, including missed opportunities related to quality of care, lack of oversight into network performance, and losing potential earned shared savings dollars on post-acute care (PAC) patients.

In a value-based care (VBC) world, ACOs are responsible for the entire patient journey; therefore, their long-term success and financial viability are inherently tied to the performance of their PAC providers. As the majority of ACOs are building preferred post-acute networks, there is still a lot of work to be done in creating successful care coordination efforts that align with VBC initiatives.

Though the financial impact of this effort may seem minimal – the numbers speak for themselves. The federal government has estimated that nearly 20 percent of Medicare patients return to the hospital within 30 days, costing more than $26 billion dollars annually as result of poor care transitions. With the increase in the Medicare population reaching 80M beneficiaries by 2040, this cost could rise to $88-88.5 million dollars. If ACOs don’t start creating High Performing Networks (HPN) with post-acute providers now, it will eventually cost them more by not doing anything.

How Much is “Doing Nothing” Costing Your Post-Acute Network?

There are numerous clinical and financial impacts that can be equated to ACOs lack of understanding of the impacts of “doing nothing” when it comes to post-acute spend. So, what is failing to “do something” with PAC spend costing ACOs?

Let’s take a look at some of the numbers…

• Average cost of readmissions: $17,100
• Average Medicare spend per beneficiary: $22,491.85
• Average 30-day readmission rate (SNF to Hospital): 23%
• Average cost of SNF day: $600/day ($400-$800)
• Average SNF LOS: 30 days

In a recent study by the Center for Health and Research Transformation (CHRT), it concluded that poorly coordinated care transitions from the hospital to other care settings cost an estimated $12 billion to $44 billion per year. This cost will only increase as baby boomers are estimated to double current Medicare beneficiaries by 2030, especially with 80% of this population having one chronic condition and 75% having two, and 40% requiring a SNF stay – demonstrating there is a true cost to inaction and at the forefront, it is the patients that suffer.

Redefining Transitions of Care to Drive Better Patient Outcomes 

With patients being at highest risk of readmission during care transitions, there are many factors that can be attributed to these poor transitions and the costs associated with them. Some of these include having little to no handoff between care providers, overwhelming amounts of unorganized information to review, equipment or medication issues, and patients potentially arriving in a less than an ideal physiological state.

While there are various methods to improve transitions of care, perhaps none as essential as utilizing data transparency cross your post-acute network to streamline patient care. With the ability to view and act on real-time data, care providers are able to monitor the transition process and have the ability to intervene in care if needed. By employing live data analytics, care partners are able to manage the transfer of patient orders more accurately from acute to post-acute facilities. This method also allows for a seamless transfer of any medications and equipment needed for patient care, as well as provide the ability to monitor for readmission trends.

Turning Data-Driven Strategies into Actionable Insights 

Being able to meet quality metrics, improve care outcomes, and increase earned shared savings is vital to achieving value-based outcomes. Care partners can implement data driven strategies to ensure the prioritization of patient care. This allows for PAC providers to focus their efforts on patients with multiple health risks and who are likely to be readmitted. Additionally, by utilizing live data analysis, post-acute partners are able to ease the burden associated with mandatory SNF reporting.

It is integral for ACOs to have a High Performing Network (HPN) and implement standardized clinical pathways across the continuum to reduce readmissions, LOS, and improve quality metrics. By monitoring SNF performance, re-evaluating and adjusting your HPN, and having dedicated staff- specifically for value-based populations, ACOs can “do something” to impact post-acute spend.

Sharing Data Analytics Across the Post-Acute Care Continuum 

By accessing live post-acute data, both the ACO and HPN are able to share the same, unblinded data together to build strong collaborative partnerships, improve communication, disclose best practices for identified issues, and contribute responsibility amongst the health system and PAC provider.

With post-acute data analytics, providers can improve quality of care and quality gap closures. It also allows for enhanced provider and staff efficiency during labor shortages, increased reimbursement accuracy, and improved shared savings on VBC contracts. In having the right data analytics solution, such as Real Time’s Interventional Analytics, post-acute providers can better manage patient care leading to improved outcomes.

To learn more about the ways Real Time can help, contact us today.