Achieving most of the Centers for Medicare & Medicaid Services’ (CMS) value-based care efforts requires the ability to monitor patients through the continuum of care and accurately report on that patient’s journey. It also requires that several disparate organizations coordinate their efforts and work together to achieve the best outcomes at the lowest costs.
However, this can be difficult when the metrics between acute and post-acute providers do not align, the result is often that these organizations view one outcome as having different results because they are not using the same metrics to measure it.
That is very likely to change in the near future. The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) recently announced new quality measurement goals that are designed to align with CMS’s priorities. These objectives were revealed at the group’s National Quality Summit in New Orleans.
“The goals we have established will improve the lives of the patients, residents, and families we service,” said Mark Parkinson, AHCA/NCAL president and CEO.
The goals are:
- Improve long- and short-stay satisfaction by 10 percent – or achieve a rate of 90 percent or greater
- Safely reduce long- and short-stay hospitalizations by improving 10 percent – or maintain a rate of 10 percent or less
- Improve functional outcomes (self-care and mobility) by 15 percent
- Safely reduce the off-label use of antipsychotics by 10 percent – or maintain a rate of 8 percent or less in long-stay residents and a rate of 1 percent or less in short-stay
“I think this is absolutely getting in line with what the intent of quality-based purchasing is all about, and that’s showing that you deliver quality care while being mindful of the spend of our Medicare and Medicaid recipients,” said Dianne Sullivan-Slazyk, RN, BSN, MBA, senior VP of clinical operation and chief clinical officer at StoneGate Senior Living.
“What I like that they are doing is that they are measuring the same things in the same way across the continuum. What happened previously is that every organization had different measurements, so it was hard to get a benchmark that’s across the continuum. Take readmission rates, for instance. A lot of the hospital originations – ACOs, HMOs, etc. – their definition of a 30-day readmission is still a little bit different across the continuum. Whereas with CMS, their definition is 30 days from discharge, from that last proximal stay. You have to measure it the same way to get an apples-to-apples comparison and not apples-to-oranges.”
In addition to perhaps beating CMS to the punch, these new quality measurement goals will help post-acute providers better meet the needs of their acute-care partners. As more acute-care organizations engage in value-based care initiatives, more post-acute providers will be incorporated in many integrated-care models. These post-acute organizations will need data that proves quantifiably the value they bring as partners.
Yet, as the requirements for quality measurement grows, so do the burdens of reporting. The American Hospital Association (AHA) recently reviewed regulatory compliance efforts and found that average-sized hospitals spend nearly $7.6 million each year on administrative work related to compliance, which is about $1,200 for each patient admitted. However, for hospitals that have post-acute care beds on site, those annual costs increased to $9 million.
Smaller post-acute providers cannot afford to add additional employees to manage reporting on these quality metrics. Fortunately, some of this burden can be alleviated by a proven, efficient analytics solution.
“We can advise on the best processes and insights that are available in real time to make sure that patient goals, with quality and cost, are achieved,” said Saqib Akhter, CEO of Post Acute Analytics, a company that helps health systems and providers monitor their patients in real time outside their four walls.
“Providers are able to see real-time patient total-cost-of-care, how they’re trending, whether they’re in the black or the red as it relates to each patient, patient outcomes, and high-risk triggers where they need help, so physicians can intervene in real time. The outcome of all that is better patient care at lower cost.”
“We all have finite resources,” said Dianne Sullivan-Slazyk, “but a solution like what Post Acute Analytics offers allows you to really focus on those patients that trigger as a possible high readmission rate and focus case management or transitional care services on them to help make those transitions smoother, so they don’t return to acute care.
“And being able to see all this information in one place will help improve the patient’s journey, as well. How many times is a patient asked about their medical conditions, for example, when they have a procedure? Eventually, they’re like why do you keep asking me that? Post Acute Analytics takes you along the continuum, so customer satisfaction is higher because the product helps the clinician and helps patients through the continuum of care much smoother.”