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How Postacute Care is Evolving

By Christopher Cheney  
   December 14, 2015

Lisa Thomson

The fee-for-service payment model has created siloed healthcare for acute care, postacute care, and home care, Thomson says, noting value-based reimbursement models such as bundled payments are encouraging all healthcare providers to focus on placing patients in the most clinically appropriate and cost-effective settings.

"With more coordination, the acute care staff has additional confidence to move the patient to the SNF setting, based on the collaboration, which required streamlined clinical systems and expected quality outcomes for the patient across all healthcare settings. The SNF feels good because they can transition the patient to a home care partner. They are all looking at the patient as a whole," she says.

In a key financial development, value-based payment models such as Medicare's bundled payments for joint replacements have resulted in an unprecedented level of data sharing, Thomson says, adding that many health systems and hospitals are gaining access to SNF billing data for the first time. "We are seeing hospitals that are looking at the data, looking at the outcomes, and identifying the SNFs that they want to work with, based on their organizational data."

As AHN has discovered with its SNF partners, skilled nursing facilities are being drawn financially to the steady patient volumes linked to closer relationships with health systems and hospitals. "SNFs will not have the higher volume of Medicare referrals with a shorter length of stay. It's a win-win clinically and a win-win financially for everyone," she says.

The Medicare payment penalty for readmissions is just the beginning of value-based care's financial impact on the postacute care sector, Thomson says. "Readmissions are the first common ground of collaboration between all of us in the care continuum. We all have to work together to keep our readmission numbers down. That's just the first of many quality measures coming down the road for the whole healthcare continuum."

Revolutionary change comes with a measure of pain, she cautions. "It forces us as organizations to determine what we are really good at and to find opportunities to do the best that we can for our patients. It will result in better outcomes, but it will be difficult. But when I see facilities embrace it, they are really energized."

Transitional care coordination
Medicare reimbursement for transitional care started in January 2014. With financial support from the nation's largest payer, transitional care has the potential to raise care coordination for older patients to new heights.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


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