THE GOOD NEWS is that QSAP (Quality supplemental Payment Program) incentive plan encouraged in the Affordable Care Act is working! The intent was to encourage the formation of accountable care organizations in an effort to improve health care quality and slow the growth of health care spending. Accountable Care Organizations embody a set of healthcare providers, including primary care physicians, specialists, hospital and long term care facilities that work together collaboratively and accept collective accountability for the cost and quality of care delivered to patients.
In California Department of Public Health is partnering with California Department of Health care Services to implement this new program. The department’s Center for Health Care Quality is assessing and scoring quality of care of skilled nursing facilities to determine scores that qualify skilled nursing facilities for supplemental payments. Qualified participants can expect to receive payments from the $90 million dollar fund as determined April 23, 2015. Electronic fund transfers will be received April 27, 2015.
Out of 1000 skilled nursing facilities, 363 received incentive awards for their performance. The individual facility payments ranged from $4000 to $1.2 million, an average of $223,000. 185 facilities that qualified for improvement awards ranged from $800 to $213,000, averaging $49,000 per facility.
The scoring of the quality of care is intensive and extensive. It covers every aspect of the operation as well as the condition of the physical plant. The methodology of scoring is still pending. Skilled Nursing Providers are adapting to the Culture change in long term care. Therefore, scoring facilities for quality of care is not only based only on the physical condition of a patient or a reduction of hospital readmissions, but the “wellness” of the patient care is of prime importance. The industry is becoming far more sophisticated and making quantum leaps. Providers bottom line is increasing while patient care quality increases. THE NEWS IS GOOD FOR BOTH SKILLED NURSING PROVIDERS AND FOR THE SENIOR POULATION REQUIRING LONG TERM CA
A number of my other Blogs addressed the impact that the Skilled Nursing industry has been experiencing with HISP, (self-insurance), dual eligibility and early hospital readmission penalties. This blog explores the brighter side. There are many positive steps being taken by Nursing Home Providers and all healthcare providers that reflect the shift from the historically operated and regulated institutionalized medical/residential facilities to person-centered care based on the belief that values and wishes of residents should be honored by those working directly with the residents, and those individual values and wishes are of prime importance. By the 21st century most providers were aware that the nursing home and healthcare providers of the past no longer met the needs or the demands of the generation seeking transitional care or long term care. The following reflects examples of how some providers have met the challenge of Culture Change:
Village Care in New York became aware that they needed to distinguish between the residents that were looking for short term care and those that required long term care. They found that most of their residents were interested in getting quality care and returning home. Village care responded by creating a plan that would build a unique, new short-stay plan program that would help people heal and recover faster and therefore return home sooner. The needs and desires of the individual became the paramount concern of Doctors, nurses and care givers and all employees of Village Care. The consideration of the needs of today’s patient, and the demand in the community for high-quality post-hospital rehab, shaped the plan and design for the Village Care Rehabilitation and Nursing Center, defining its role in New York City healthcare.
The Green House Model was developed by Dr. William Thomas which is a radical departure from the traditional nursing home’s institutional setting and mindset. The Green House model by design and philosophy encourages small groups of residents and staff to become a community which together promote high quality care respectful of each resident’s individual wishes. The change in emphasis necessitates a different approach to facility size, interior design, staffing patterns and methods of delivering skilled professional services. The project is active in 32 states with 134 homes open and 106 homes in development since May 2012.
Some of the changes on the road to a more person- centered, homelike resident experience are untested and their outcomes are therefore uncertain. To improve life quality of residents in nursing homes, assisted living and continuing care residential communities, regulations and courts must accommodate necessary innovation and its uncertain consequences in ways that reward and encourage rather than punish culture change. The healthcare industry is on a move. The healthcare industry, like all of us, are struggling to adjust to the new 21st century demands of a fast changing technological age. Trial and error persists, mistakes are made and it seems like we are all slow learners. However, the intentions of the majority are good, even though sometimes the outcome is disappointing, but out of the struggle comes the progress in the healthcare industry, as well as in all of our lives.
Future Healthcare Trends: What the experts are saying.
The Baby Boomer Generation, Technology and Coordinated Healthcare are the three critical elements shaping the future of Assisted Living, Independent Living, Continuing Care Communities and Skilled Nursing Facilities as reported by many of the experts in the Healthcare Industry.
As Baby Boomers approach retirement age, the senior living industry has to address the needs and demands of the Boomers who are active, tech-savvy and who are living longer. Boomers will approach retirement in a whole new way. Providers of healthcare facilities must keep up with the demands in order to stay in business and be competitive. In the future expect to see more emphasis on amenities. It will be easier for larger communities like CCRC’s to offer a wider variety of events and services. Boomers want to be more physically and mentally active. Senior living communities will offer more education opportunities, including online learning options. There will be more recreational and fitness options promoting ‘whole person wellness” which observes the physical, emotional and spiritual aspect of the retiree. Diversity is important to Boomers because they grew up during a radically different social and political environment than previous generations. Retirement communities for distinct ethnic groups, which offer the benefits of a common language and culture will be an option offered to seniors. Other communities will be designed to offer lifestyle choices.
The experts report that technology creates the greatest difference between the life of seniors of the past generations and the lives of Boomers and future generations. Baby Boomers are particularly tech-savvy and will drive the senior living industry toward wireless connectivity. “Smart homes” are built to accommodate wireless technology to help boost the independence and safety of older adults. Seniors are able to be more independent and also are able to contact family and care givers when needed.
Collaboration and Integration in the Healthcare Industry are aspects which are changing and shaping the future as Providers seek additional strength to cut costs and improve the quality of care for residents. As reported by Dr. Thomas Lee at the October Nic conference there is a great need for collaboration and integration of organizations that work with seniors, including healthcare providers and housing groups. Vertical Integration between types of Senior Care effectively organizes senior care between senior community and hospital. Evidence of this trend is notable today and will become a driving force in the future as the Healthcare industry gains more sophistication.
So the future looks bright for the Healthcare Industry. Retirement takes on a completely new look as providers adjust and comply with the needs of the upcoming generations. Existing providers recognize and respond to the change, and new investors to healthcare are emerging to bridge the gap between supply and demand.
The Skilled Nursing and Rehabilitation market is in the midst of a transformation and faces a new world of accountability and readmission penalties. There is a long overdue interest and awareness that nursing home providers provide the key that can reduce unnecessary hospitalizations which trigger financial penalties for both the Skilled Nursing provider and the Hospital. With the realization that private and public payers are committed to VALUE BASED HEALTH CARE, the days are over when financial success was tied to the census of a hospital or a skilled nursing facility.
THE HOLDING HANDS RELATIONSHIP is new and demands cooperation from both hospital and skilled nursing provider. Both share the goal of avoiding unnecessary inpatient stays, but a hospital’s facility, protocols and standards are very different from those of a SNF. Furthermore, the communication gap between the two providers is great. Nursing homes frequently do not receive the information they need to properly care for patients discharged from the Hospital. Although there are many programs that address the problems of the marriage of Hospital and Skilled Nursing Facilities, the financial incentive to change to valued based health in the short term view, is not as important to a skilled nursing provider as it is for the hospital. Cut in reimbursement rates for readmission are significant for hospitals, not for all skilled nursing facilities yet, but the handwriting is on the wall.
THE GOOD NEWS IS the skilled nursing provider doesn’t get off the hook, which is a tribute to the fact that the healthcare industry is “growing up” and adjusting to the demands of the culture. For example, a good many health systems are creating a network of SNF’s that agree to meet quality standards, share data, provide certain services and work with hospitals to reduce, avoidable hospitalizations. Upon discharge from a hospital, a patient is given the list of approved skilled nursing facilities that have met the Hospitals requirements and are included in their network. Of course the patient can choose any nursing facility, but hospitals can help patients make good choices. If a skilled nursing facility becomes a preferred provider they enjoy increased census and increased revenue. In the long term when unnecessary hospital readmission from nursing homes reduces their reimbursement rate, the skilled nursing will survive that has developed a value based health care plan. The ones that do not meet the new higher standards will not survive or end up in the bankruptcy court.
AND SO THE BEAT GOES ON! The result of all the effort by various organizations like the Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation is resulting in the integration of hospital and acute care providers. The result is lower costs and improvement in the quality of care. The entire healthcare industry is becoming more sophisticated and in the big picture is making giant steps in achieving what is necessary to create a structure that will support the goals of Value based care as well as financial reward.