New Payment Model Treats SNFs More Like Hospitals

As part of the ongoing effort to reduce hospitalizations of skilled nursing residents, some providers will be eligible for increased payments to beef up their services, the Centers for Medicare & Medicaid Services (CMS) has announced.

Skilled nursing facilities participating in Phase Two of the Initiative to Reduce Preventable Hospitalizations will receive payments for multidisciplinary care planning and to boost their ability to care for six medical conditions that are commonly associated with hospitalization. These conditions are: pneumonia, dehydration, congestive heart failure, urinary tract infection, skin ulcers/cellulitis, chronic obstructive pulmonary disease, asthma. 

“Removing potential barriers to effective treatment within a facility can improve the residents’ care experience and mitigate the need for disruptive and costly hospitalizations,” CMS stated last Thursday in its announcement of Phase Two. “For example, participating skilled nursing facilities will be expected to enhance their staff training and purchase new equipment to improve their capacity to provide intravenous therapy and cardiac monitoring.”

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Physicians also will receive equal Medicare reimbursements for comprehensive assessments in SNFs and in the hospital under Phase Two of the initiative, CMS stated. Currently, physicians receive lower payments for assessments in SNFs.

The new four-year phase of the initiative is scheduled to begin in the fall of 2016. SNFs associated with six selected Enhanced Care and Coordination Providers (ECCPs) will be involved. The six awardees are:

– Alabama Quality Assurance Foundation (Alabama)

– HealthInsight of Nevada (Nevada and Colorado)

– Indiana University (Indiana)

– The Curators of the University of Missouri (Missouri)

– The Greater New York Hospital Foundation, Inc. (New York)

– UPMC Community Provider Services (Pennsylvania)

These organizations will implement the new payment model in their existing partner facilities and in a number of additional facilities to be recruited over the next several months.

The Initiative to Reduce Preventable Hospitalizations began in 2012. The ECCPs participating in Phase One currently collaborate with 143 long-term care facilities, providing preventive services, assessment and management of conditions, and on-site staff training. The project has been successful in achieving declines in all-cause hospitalizations and potentially avoidable hospitalizations, according to CMS.

Written by Tim Mullaney

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