The Centers for Medicare & Medicaid Services is providing skilled nursing facilities with a peek into how some top hospitals are picking preferred skilled nursing partners, with some developing scorecards or even ranking them from “bronze” to “gold.”

A new toolkit from the agency also outlines some of the innovative strategies Medicare accountable care organizations are using to cut costs and coordinate care — and nursing facilities are often playing a key part. Many hospitals have decided to work only with SNFs that demonstrate the ability to consistently provide high-quality care, with a willingness to reform how they deliver services, CMS wrote.

Other ACOs are developing scorecards on their skilled nursing partners to help deem which can remain in their trusted circle. Facilities are typically rated on how well they prevent readmissions, improve patient independence and save dollars by reducing lengths of stay.

“One ACO described how it removed SNFs that repeatedly fail to meet performance targets from the high-performance network,” CMS noted.

Another accountable care organization, meanwhile, calculated a single-performance score for nursing facilities, and placed them in one of four tiers — standard, bronze, silver and gold. Those who landed on the higher levels received greater access to quality improvement support from the ACO, motivating nursing facilities to provide data to the organization, and maintain high quality care.

ACOs are also putting pressure on skilled nursing facilities to perform by dedicating staffers to improve care coordination following discharge. Those caregivers might be embedded within the SNF or available by phone from a centralized ACO office.

“Although ACOs acknowledge that dedicated staff are a financial investment, they noted that these staff have meaningfully improved the beneficiary’s care experience and lowered the rate of inpatient readmissions,” CMS wrote.

Along with the 14-page toolkit, the agency also released several case studies last week, detailing how individual ACOs are working more closely with skilled care providers.