Study reminds providers about the tough prospect of putting up or stepping aside

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James M. Berklan
James M. Berklan

My friend Rich admittedly didn't know much about the group of school kids he was about to oversee. But as a business manager, he told me he had his own favorite method of ironing out disagreements between two squabbling parties.

Stop the emails, third-party negotiating and excuse-making. Just put them face-to-face in a room together. It's a subtle form of pressure that can sometimes be not-so-subtle, depending on the stubbornness of the participants.

Sure enough, I learned that most often, the one with a weak leg to stand on or more bluster than believability was exposed and backed down. Some sort of compromise, and usually a better way of doing things, emerged.

Rich didn't necessarily know the details of the program, but he knew how to get results and he did it while wearing a very sincere-looking smile.

It's a surprisingly effective tactic, as long as it is accompanied by adequate oversight — in the kids' case someone like Rich, or Mom and Dad.

Or, as providers are about to find out over the next several years, Uncle Sam. Yes, the good uncle is going to compel compliance and better patient outcomes, with or without smiles.

A McKnight's Daily Update article on Tuesday illustrated the point thoroughly.

There is no turning back from the current push for value-based purchasing of services (as opposed to a quantitative fee-for-service structure), or the quest for lower hospital readmissions.

The headline on the Daily Update item bugles the mortal danger of being re-admitted to the hospital from a skilled nursing facility. You know some of the themes: Patients returning to the hospital after 14 days are in the most danger. Those who return to the hospital 30 or fewer days after leaving it are twice as likely to die than those who remained in a skilled nursing facility. A return to the hospital fewer than 100 days after discharge doubles the risk again, according to University of Colorado School of Medicine researchers.

The study examined 3,200 Medicare beneficiaries' records from 2003-2009. The time period is key because it is before penalties began for hospitals with readmission rates that are deemed too high. Rushing patients out of the hospital, perhaps before their proper time, was incentivized, researchers pointed out. It likely contributed to the nearly 23% rehospitalization during the study period.

It is just another nail in the coffin of pure fee-for-service, and another reason why we hear so much of “value-based purchasing” nowadays. Value-based simply means, “We pay for solved problems. Period.”

Right now solving the (readmissions) problem lies primarily in hospitals' lap. Skilled nursing facilities, technically, still haven't been brought into the room for a showdown. Sure, they are impacted by the struggle, but it's merely by association thus far. While their Medicare funding stream won't be docked for being a poor care-transitions partner, they can lose out by having a poor reputation that leads to fewer hospital referrals.

However, beginning in 2018, nursing homes also will be docked a percentage of Medicare funding if hospital readmissions are too high.

If they haven't realized it already, hospitals and nursing homes are being herded into the same room by Uncle Sam. It's time for the sometimes squabbling, sometimes competing factions to play nice together and come up with better solutions.

Both win, or neither wins.

The researchers drop responsibility for high readmissions in the laps of both: "Readmission risk factors may signify inadequate transitional care processes or a mismatch between patient needs and PAC resources," they say.

What that means for long-term care providers is two things: Your performance is going to be scrutinized more than ever before, both at the local and macro levels. You knew that, but this study shows the impact better than ever, as well as where weak points might exist.

It also means it would be better if you jumped into a room with your nearest hospital(s) as soon as you can, and lock the door behind you. Start collectively figuring out a better way of doing things.

Get started on solutions as quickly as you can. Sooner than later, the weak, the disinterested, the excuse-makers will be exposed.

And Mom, Dad, Rich – and Uncle Sam, with all of his bags of money —  will know who you are.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.