Accurately performing assessments and documenting patient care should be more of a priority for skilled nursing facilities in the future.
Not only because operators are facing more MDS coordinator shortages and outsourcing the process as a result, but also reducing hospital stays could be a way for NFCs to capitalize on value-based care.
At least that’s the case with SNF’s Value-Based Purchase Program (VBP).
The question for operators is whether the juice is worth it.
The program is designed to award SNFs with incentive payments based on the quality of care they provide to Medicare beneficiaries, according to the Centers for Medicare & Medicaid Services. If a facility does not submit the required quality data, it could be subject to a two percentage point reduction in the annual payment update.
“Keep in mind that 2% when you talk to staff about it, they don’t think that’s a lot,” explained Susan LaGrange, chief nursing officer at Pathway Health, during a presentation at the LeadingAge Illinois conference on last month. “That 2% is a lot and it adds up and adds dollars that you can use for staffing.”
Is 2% enough drawdown?
However, not everyone is convinced that the incentive is enough to involve nursing homes.
The Medicare Payment Advisory Commission (MedPAC) recommended eliminating the program last year, in part because the relatively small size of the incentive payments might not be enough to motivate providers to improve.
ATI Advisory’s managing director, Fred Bentley, also expressed concern over whether 2% is really enough to get the industry’s attention.
“It’s not upsetting,” he told Skilled Nursing News. “It’s a totally different story when you’re talking about 5%.”
Although Bentley hasn’t heard any indication that CMS plans to increase the percentage at this time, policymakers and industry gurus have discussed the possibility and he foresees a push to put more “teeth in” the program.
Still, LaGrange believes now is the time to prioritize proper coding and additional data logging through education and training — especially with the White House backing the SNF VBP program these last months.
She said ‘every dollar’ is important to care homes right now, a message that needs to be widely understood by staff in the future.
Marc Hudak, director of growth for the health plan for longevity, thinks operators need to look forward when it comes to the program and look to value-based additional care opportunities in the future.
“On the one hand, 2% doesn’t seem like a lot, but when you understand the cost pressures operators have faced, I think every piece counts,” he told SNN.
The “broader theme” is that, as CMS and the White House continue to articulate their intent to direct reimbursement towards more outcome- and value-based measures, the importance and relevance of the program will only than grow, added Hudak.
The White House ordered CMS to propose new payment changes based on staff adequacy, resident experience and staff retention as part of its efforts to strengthen the program.
Just because it is 2% today does not mean it will be 2% tomorrow, he added.
“So 2% today could be 10% at some point,” Hudak said. “CMS said they want everyone to be in a value-based model by 2030, so I think that’s very relevant and although it’s small today, that’s where the industry is steer in haste.”
Onboard agency staff
At a time when 71% of operators have taken on interim staff in the past few months due to staffing shortages, it’s not always easy to engage every staff member and motivate them to recoup incentive payments. for installation.
Bentley said “smart SNFs” were doing what they could to minimize the use of agencies, although he admitted relying on temporary staff could be “disruptive”.
“We have heard of cases where it is this staff revolving door and they [aren’t always] really committed,” he added.
While agency staff can make things “trickier,” according to Bentley, some operators structure contracts to hold staff members accountable for performance on hospital readmissions in the same way they would hold their own staff accountable.
The program primarily assesses a nursing home’s performance based on a 30-day hospital readmission measure – scored on both improvement and success – and is expected to the program is expanding soon with other measures under consideration such as exit models.
Hudak added that one of the challenges with hiring large numbers of temporary or interim staff is that they come in and aren’t trained in operator protocol and best practices.
“If someone wakes up with a fever or a urinary tract infection, [an agency staffer] can send them straight to the hospital instead of just calling the on-call doctor who has a plan in place,” he said. “It’s an absolute challenge.”
Give staff the tools they need to succeed
The best way to ensure mistakes are not repeated when it comes to quality coding and reporting is to conduct a needs assessment to determine what a facility’s staff do well and what they doesn’t, according to LaGrange.
“It’s so important to have a good process to identify changes and really manage quality of care to avoid these unnecessary readmissions,” she said. “If the staff understands that they are providing the establishments with more money to be able to take care of the residents.”
LaGrange added that it’s not just temporary staff and new staff members who may struggle to complete assessments and document changes in a patient’s chart.
She has seen cases where a change in condition has been made and the assessment is not documented on the record – not through negligence but through misunderstanding.
“Take a look at your system for condition changes and your nurses’ assessment skills,” LaGrange said. “We have very good nurses and they have provided good care to your residents, but times have changed.
Missing or inaccurate assessment data may not be a sign that the nurse does not want to do it, but rather that she does not feel comfortable because she has not done this type of assessment from nursing school.
“It’s really taking a step back and taking a look at what you need to do because if we can take our nurses that we have today and show them and teach them and put them at ease, you going to see a lot more compliance with those assessments and with that documentation process,” she added.