Skilled nursing facility readmissions should be an ACO quality measure, government proposes in payment rule

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 Skilled nursing facility readmissions should be an ACO quality measure, government proposes
Skilled nursing facility readmissions should be an ACO quality measure, government proposes

Accountable care organizations should be assessed on the number of people who return to a member hospital within 30 days of being discharged to a skilled nursing facility, the Centers for Medicare & Medicaid Services has stated in a proposed rule.

The SNF readmissions figure is one of four new ACO quality measures floated in the proposed physician fee schedule for calendar year 2015, issued July 3. The measure would track the number of all-cause, unplanned hospital readmissions for skilled nursing patients. It would cover a 30-day window starting from the time of discharge from a hospital, critical access hospital or psychiatric hospital to a SNF.

ACOs in the Shared Savings Program “often include post-acute care (PAC) settings and the addition of this measure would enhance the participation and alignment with these facilities,” the proposed rule states.

Hospitals and other healthcare providers that form ACOs have financial incentives to coordinate care among themselves, with the goal being to lower costs while improving outcomes. Their bonus payments are based in part on whether they meet quality measures.

The skilled nursing readmissions measure would be calculated through claims data and so would not impose a reporting burden on ACOs, according to the proposed rule.

The proposed rule also describes a new Medicare payment for chronic care management, which would reimburse physicians for services such as communicating with other healthcare professionals and overseeing medication management.

The chronic care reimbursement is a positive development but is “overshadowed” by the failure of lawmakers to permanently repeal and replace the Sustainable Growth Rate formula for calculating doctors' Medicare reimbursement rate, the American Academy of Family Physicians stated in a comment on the proposed rule.

Congress already has extended current payment rates through March 2015 and routinely enacts “doc fixes” to prevent SGR-mandated cuts. These would be upwards of 20% for 2015.

Click here to access the complete proposed rule, scheduled for July 11 publication in the Federal Register.

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