Patient SNF choice still reigns in bundled payment model

Elana Levinthal Stair
Elana Levinthal Stair

Despite the heavy emphasis on partnerships between skilled nursing facilities and hospitals participating in a bundled payment program for hip and knee replacements, patient choice should ultimately prevail, experts shared during a McKnight's webcast on Thursday.

Hospitals participating in the Centers for Medicare & Medicaid's Comprehensive Care for Joint Replacement Model have plenty of incentives — including a waiver of the three-day rule — to advise patients on choosing an SNF within a network of trusted providers. But should a patient choose an SNF outside of the hospital's network, the hospital “cannot stop” the patient, said Elana Levinthal Stair, health director at Avalere, during the webcast.

“Patient choice is still the law of the land,” Stair said. “CMS doesn't have the authority, nor do I think they would ever want, to limit patient choice.”

The three-day stay waiver included in the CCJR model comes with a caveat an SNF must have three or more stars in order to receive patients whose three-day stay requirement has been waived. While that limitation has “huge implications” for providers in terms of being included in a hospital's partner network, a patient's choice would win out, Stair noted.

“If the patient chooses the SNF, then that's where the patient will go,” Stair said. “If that particular SNF of choice is not a three-star SNF, then the hospital can't use the waiver.”

The webcast also shared key steps providers in one of the CCJR's 75 markets can take to position themselves for success in the program, including:

  • Collecting data and metrics on their facilities, as well as on competitors and potential partner facilities

  • Understanding CCJR hospital's pain points and how they align with their data

  • Telling hospitals their “value story,” including benchmarks that show how they would manage CCJR episodes

Click here to view an archived version of the webcast.

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