Welcome to 2020! Last year was a big year for post-acute care with many long awaited regulations going into effect as well as a complete change of the reimbursement system. While these changes started in 2019, it is safe to say we won’t truly understand the full effect of them until well into 2020 and after. In fact, many of us are still trying to fully understand them and how they will actually affect post-acute care patients and providers. In the end, these changes are designed to make the post-acute care world more efficient and quality focused so we can expect 2020 to be a very good year for post-acute care and transitions industries.
Read our article that reviews major post-acute care developments that took place in 2019.
Increasing consumerism within health care can be expected throughout 2020. With the continuing transition toward value based care, there has been a much greater focus on primary customers in healthcare and providers must be more attentive toward their wants and needs. Patients are now involved more than ever in making choices about their health care. As patients are paying higher amounts out-of-pocket for care, they are also becoming more selective about their care. Patients and families are looking at reviews and want more information about providers before making a selection. Additionally, quality ratings are more important than ever and are affecting consumerism. With the new medicare discharge planning regulations, quality ratings are required to be given to each patient. Thus, this rule has meant primary consumers are using quality ratings to screen for providers, and marketing has become critical for providers to obtain new patients. Overall, we can expect consumerism to play a large role in shaping healthcare in 2020.
To learn more about consumerism in healthcare, read our blog post on the topic here.
- Patient Driven Payment Model (PDPM)
The Patient Driven Payment Model (PDPM) for SNFs went into effect in October of 2019, but we have yet to determine the true impact of this change. PDPM is expected to shift service delivery, as it focuses on individual patient characteristics rather than volume of care provided. This new payment model is an attempt to improve the accuracy, reduce burdens, and improve payments to underserved CMS beneficiaries. However, with these changes there will be both intended and unintended consequences that will impact the reimbursements as well as the type of care patients will receive at SNFs. For example, with the increased focus on quality over quantity in therapy hours, SNFs may see a potential loss in therapy reimbursement. However, it is anticipated that this can be neutralized by an increase in reimbursement in nursing care. Although this new payment model’s strict regulations may seem like a burden to post-acute care providers, over time it will likely improve the quality and efficiency of their rehabilitation as SNFs will now need to be diligent and precise in documenting how they provide patient care. Specific classifications of patients and variable per diem rates may incentivize facilities, who would have previously seen a negative impact on their revenue, to take in more complex patients. Skilled Nursing News predicts that respiratory therapy and services, like ventilator and tracheostomy care, could potentially emerge as key revenue sources due to their high reimbursement rates. While PDPM went into effect in 2019, it is likely to be a major player in the shaping of skilled nursing in 2020 as we have not yet seen the full effect it will have on the industry.
- Patient Driven Groupings Model (PDGM)
Home Health has a new reimbursement model, PDGM, which went into effect on January 1, 2020. PDGM is a newer version of the Home Health Groupings Model, which was greatly unpopular. PDGM is required by the Bipartisan Budget Act of 2018 and is budget neutral, thus this change should have no long-term budget impact. This change comes as part of a mandate from congress for Medicare to shift toward a focus on value of care. Thus, reimbursements for home health will no longer be determined by the volume of therapy. Similar to the PDPM model for SNFs, this is a more patient centered reimbursement model. PDGM will change the unit of care payment to 30 days from 60 days, and will remove incentives to provide copious amounts of therapy to every patient, instead focusing on unique patient needs. To assist with these major changes, upon request CMS is offering providers a Home Health Claims-OASIS Limited Data Set (LDS). This LDS contains information regarding utilization of the Medicare Home Health benefit, with each observation representing a particular home health episode during the year. Thus, the Home Health Claims-OASIS LDS will be valuable for home health agencies to help them navigate this change and how it will affect reimbursements and planning. CMS has made it clear that a request should be made early, and is necessary in order to access this LDS, so providers should be sure to put in such a request early in 2020, which can be done by following these instructions. It is anticipated that in order for home health agencies to have value with this new system, they will have to make data-based decisions based on constant patient monitoring and feedback. Overall, PDGM is anticipated to improve reimbursement for all home health patients and help the industry move toward value-based care, which should benefit patient outcomes. The real impact of this change will likely not be felt until late 2020 and after.
- Unified PAC Payment Model
A Unified PAC Payment model is on the horizon as the IMPACT Act of 2014 requires a design for such a model by 2024. This unified model will pay providers through a single, overarching framework. The PDPM and PDGM changes reflect a shift toward a unified model, and as we see how these changes roll out, we are likely to get a better idea of what such a unified payment model will look like in 2024. As we inevitably march toward this unified model, there have been some delays, particularly with CMS as they have their hands full with the PDPM and PDGM changes. Other players are pushing for the model faster than 2024, with the Medicare Payment Advisory Commission (MedPAC) already having stated how they would like such a model to take shape.
- Health IT-Interoperability
Interoperability is soon to be the new norm. As defined by The Office of the National Coordinator for Health Information Technology, interoperability is technology that allows the secure exchange of electronic health information with other health IT without special effort by the user. Basically, interoperability is technology that easily and quickly allows health information to be securely shared between users, whether they are at the same or different facilities. While there is already such technology within hospitals, the demand for having interoperability between hospitals and post-acute care providers is growing. The discharge planning rule that went into effect in late 2019 has requirements about patient information needing to be shared electronically between health settings, making such technology necessary for post-acute care providers. Providers are likely going to be required to invest more in technology to stay competitive by allowing faster and easier referrals. Furthermore, such interoperability allows greater communication about patients between hospitals and post-acute care providers. This is going to be necessary as we move toward value based care with a greater focus on patient outcomes. We can expect that by the end of 2020, all post-acute care providers will need a technology that allows interoperability to ease patient transitions and speed up the referral process.
- PAC Utilization Trends: What to Expect
The shift toward value based care and a focus on quality will likely shift where patients go after a hospital stay. Hospitals are more incentivised to ensure patients receive high-quality post-acute care when they leave the hospital to reduce the change of a rehospitalization. With the changes to the discharge planning rule, quality is a main focus and we can expect providers with higher quality metrics to receive more patients. Technology will also inevitably play a large role in referrals, and those providers who are able to adapt and have interoperability will be able to take more referrals and at a faster rate. The type of patient in post-acute care is also expected to shift. Patients who were previously unable to leave the hospital are now being discharged to post-acute care. Under the PDPM, SNFs will have a higher reimbursement for such complex patients, which encourages providers to offer higher level clinical services, such as ventilation or dialysis. For post-acute care providers, offering more services, marketing yourself, focusing on quality, and having competitive technology will play a large role for their utilization and overall success in 2020.
Repisodic is focused on keeping providers up to date on post-acute care news, informing them on how to navigate the ever-changing post-acute care space – we help providers excel in the future of uncertainty. The Repisodic Blog allows you to easily follow any major changes, and understand how they may affect your facility as well as what these changes may mean for your patients. Repisodic Choice can help make transitions easier for both patients and providers and help providers utilize trends such as interoperability to their benefit. Our hospital discharge solution helps discharge planners easily identify high quality post-acute care providers in any region and walks the patient through the care selection process so they can make an informed choice about their post-hospital care. To learn more about getting Repisodic Choice at your hospital, visit our page and request a demo. Additionally, Repisodic Choice can assist post-acute care providers by allowing them to have all of the information about their facility organized in a digestible manner that is easy for patients to access so they can make confident, data-driven decisions about their care. Learn more here and claim your facility’s profile.