CMS’s final bundled payment model for hip and knee replacement surgeries makes one thing clear for SNFs: A quality rating of at least three stars is more crucial than ever, especially given the changes going into effect in a little over a year.
At least, that’s the case for skilled nursing facilities in the 67 geographic areas included in CMS’s five-year test. Hospitals in those markets will be given a bundled payment to cover a patient’s joint replacement surgery as well as the subsequent inpatient stay and post-discharge care—including treatment at a SNF.
The clear incentive for hospitals is to discharge patients into less expensive post-acute care as soon as possible after surgery. CMS is recognizing that fact with a waiver of the three-day stay rule, beginning in 2017. However, the waiver only applies if a patient is discharged to a SNF that has maintained a star rating of three or more for at least 7 of the previous 12 months.
McKnight’s and Modern Healthcare have reported that currently, one in three SNFs in the test areas does not meet the three-star standard. Those facilities will likely be focusing very intently in the next year on the three categories that determine star ratings: quality, staffing and health and safety inspections. These kinds of efforts require all hands on deck, on both the clinical and administrative sides, so now is the time for everyone on the team to think strategically about how they can help improve their facilities. SNF administrators will also need to invest energy in their relationships with hospitals, ensuring strong communication so that they can be counted on as reliable, high-quality partners.
SNFs that are not located in the test markets may be breathing a sigh of relief at the moment, but experts caution it’s not time to rest on their laurels. With Medicare’s ongoing push to tie payments to quality—and to make quality measures more visible to patients—star ratings are becoming one of the most important vital signs for SNFs.