During a recent public meeting, the Medicare Payment Advisory Commission (MedPAC) proposed a new program that would expand the value-based impact on payments for post-acute care providers.
According to MedPAC, the Value Incentive Program for Post-Acute Care will build upon previous commission work to create a uniform payment system across the four post-acute care settings: skilled nursing facilities, home health services, inpatient rehabilitation facilities and long-term care hospitals. Quality of care would be more aggressively tied to payments in an effort to incentivize improvement.
The PAC-VIP will focus on a small number of “risk-adjusted, claims-based measures,” including all-condition hospitalization within the post-acute care stay, successful discharge to the community and Medicare spending per beneficiary. Performance will be scored using “absolute, prospectively set targets” and providers with similar shares of dual-eligible beneficiaries will be compared to ensure social risk factors are accounted for.
Similar to other Center for Medicare & Medicaid Services value-based programs, MedPAC proposed a 5% withhold to fund the incentive payments but said that number could change based on member feedback.
Patient experience will have a greater payment impact
One of the biggest takeaways for post-acute care providers is what MedPAC members pointed out about existing SNF value-based payment programs — particularly that they lack any patient experience measures.
By contrast, in the acute care setting, feedback regarding patient engagement and satisfaction currently contributes to 25% of payments. This data comes from the 27-question Hospital Consumer Assessment of Healthcare Providers and Systems, which is mandated by CMS and required for all U.S. hospitals.
FY 2019 Hospital VBP Program Measure
Based on the MedPAC meeting and the PAC-VIP program proposals, collecting patient experience data will become critical for post-acute providers.
Below are five factors to consider as patient satisfaction gets closer to impacting reimbursement:
- Collect and report CoreQ to lead support for a more manageable survey.
The simple CoreQ 4-question survey is easy to integrate into an existing post-discharge survey. Though short, it provides valuable insight into how providers compare with their peers and has far fewer regulations regarding the collection of data. While it may be tempting to collect CoreQ data only for internal quality improvement, reporting your scores to the LTC Trend Tracker will let you know how you compare geographically and may make it a contender when a survey is mandated.
2. Add additional questions to identify areas for improvement.
Adding open-ended questions on areas to improve may provide important insight into ineffective operations or specific issues. Some quality issues, such as faulty equipment or problems with personnel, may be under the radar of leadership until pointed out by a patient.
3. Mitigate potential legal issues with real-time responses.
If collected in real time, patient experience feedback can help avoid potential legal issues. The shorter the lag time between gathering negative feedback and making sure it is seen by the right people, the better your odds of resolving an issue before it escalates.
4. Implement telephone surveys.
Telephone surveys tend to have better, more accurate results than surveys sent via mail, and research has shown that phone calls increase the propensity for more favorable evaluations of care. CMS recognizes this and has an adjustment for surveys collected over the phone.
5. Reach more patients.
The larger the patient sample, the more reliable the information and the more confident you will feel knowing exactly which areas to focus on for improvement. In addition, studies examining the response rates of publicly reported hospital patient experience scores found a correlation between increasing response rates and higher HCAHPS dimension scores.
Get a head start on utilizing patient experience measures
The recent shift toward value-based care is expected to continue as providers nationwide are under increasing pressure to improve patient outcomes while reducing overall health care costs.
According to MedPAC members, the proposed PAC-VIP goals are necessary because existing VBP programs for SNFs and home health agencies do not meet commission standards. If you are a post-acute care provider and you do not currently have a system in place for collecting and measuring patient experience data, you should consider implementing changes to your post-discharge program to meet the new performance targets and avoid potential penalties.
Ryan Sparks, MS, MBA, is a co-founder and Chief Revenue Office of Nexus Health Resources