The design of the BPCI-Advanced program appears, at first glance, to offer little opportunity for SNFs looking to redesign their business models and take episodic healthcare risk alongside hospitals and payers. It effectively sunsets the original BPCI option that kicked off the risk-based episode at post-acute admission (called “Model 3”), leaving all bundled post-acute services to start with either an inpatient or outpatient service.
Ever since the ACA became law in March 2010, HHS has set a breakneck pace for transforming traditional Medicare fee-for-service payments into a value-based system; with Obama’s HHS Secretary projecting that nearly every fee-for-service payment the agency makes in 2018 would be tied, in some way, to value.
Current modes of long-term care service delivery, such as assisted living, nursing home and private duty home care providers, will lose unless they begin to innovate a patient-centered, setting-agnostic platform that meets a much broader array of family needs.
One area where many SNFs have room to improve is medication management. Optimizing medication management services during care transitions will position SNFs as high-value partners in the preferred referral networks of hospitals and health systems.
If new payment reform initiatives sowed the seeds of small disruptions in 2013 — narrowing referral networks and prompting clinical integration, those seeds will start sprouting bigger disruption across multiple markets in 2014. This year ACOs will proliferate and will include SNFs in a real way. Bundled payment experiments will be beginning all over the country.
In the rapidly changing healthcare delivery system, SNFs will need to implement strategies to integrate physicians to retain their market share and be competitive. The incentives inherent in value-based reimbursement necessitate a transformation on the part of SNFs.
Post-acute care providers must be proactive and initiate conversations with hospitals and other community provider partners to ensure they are at the table when strategic partnerships are developed. They must come to these conversations armed with a more sophisticated understanding of their own readmission rates and a clear roadmap on how they plan to reduce them over time.