Providers that were hoping to see adjustments to value-based purchasing programs based on the social risk factors of the patients they serve may likely have to wait until larger revisions to healthcare reform are settled. This is much to the dismay of hospitals and skilled nursing providers that are being disproportionally penalized due the populations they serve. 

The latest evidence of this imbalance was cited in the Health and Human Services “Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Payment Programs,” which was released at the end of December. The report reaffirms that providers who disproportionately served beneficiaries with social risk factors tended to have worse performance on quality measures. Similarly, under value-based purchasing programs in which penalties are currently assessed, these providers experienced higher penalties than did providers serving fewer beneficiaries with social risk factors.

While a timeline for policy change that address social risk factors could be years away, skilled nursing providers currently face readmission quality measures with the addition of SNFVBP Program slated for fiscal 2019.  Some steps that skilled nursing providers can take now include the following:

Identification of the social characteristics of your population — While most providers are likely aware of the of socio-economic factors in their geographical area, having data on your population can indicate which factors are the most prominent and can also provide a comparison of the same factors in other locations.  The American Community Survey (ACS) provides an interface to search social, economic, housing, and demographic characteristics by specific geographical areas. This allows providers to see the level prevalence of such factors household income below the poverty level or education attainment levels of the population they serve.  

Identifying and building relationships with community services — When a resident transitions to home from a skilled nursing center, additional risks can occur if the resident faces socio-economic challenges. Identifying and utilizing locally available community service programs and establishing contacts in those programs can ease the transition and protect the resident. Building a list of programs for reliable food sourcing, transportation and suitable housing and identifying the corresponding contacts in each support component are central to the effectiveness of the service.

Reminding Hospitals and ACOs of stable environment that SNFs provide — An interesting finding of the HHS study is that, like hospitals, ACOs, physician groups, raw readmission rates in the SNF setting were much higher for populations with social risk factors. However, unlike hospitals, ACOs, physician groups, these effects were almost entirely accounted for by the adjustment models that accounted for variables, such as age, gender, and comorbidities.  

A finding that was illuminated by the lack of major differences in readmission rates between dually-enrolled beneficiaries and non-dually-enrolled beneficiaries. The report attempts to explain this finding by proposing that skilled nursing facilities differ from other settings. Specifically, when beneficiaries are discharged to SNFs, access to shelter, food, their medications, and a degree of medical and other services and supports are more consistently available than in their home. The report proposes that the reason the results do not yield significant differences in readmission rates between dually-enrolled beneficiaries and non-dually-enrolled beneficiaries is because this common environment may meet needs that may go unmet in other environments.

The recent HHS report provides recommendations to lawmakers on how to adjust value-based payments that reconcile the impact of providers serving patients with socio-economic challenges. However, with the uncertainty of the new administration and the potential changes to the affordable care act, the timeline for any adjustments is uncertain. Therefore, providers need to take action to improve processes internally until such time as new reforms are in place.

Ryan Sparks is the co-founder and chief revenue officer of Nexus Health Resources.