Hospitals had to reduce readmission rates. Now it’s the post-acute sector’s turn.
In 2012, Medicare’s Hospital Readmissions Reduction Program (HRRP) required hospitals to reduce their own 30-day readmission rates or face potential payment penalty. Now it’s the post-acute care (PAC) market’s turn to help reduce hospital readmission rates or face consequences.
What does this mean for home health, hospice, long-term care and skilled nursing facilities? PACs now must put even more focus on keeping patients as healthy as possible to avoid readmission. With more Americans going into PAC settings than ever before, the shift to a value-based care model and focus on care quality is here to stay. And so are regulations from Medicare that help keep costs down.
Multiple pieces of legislation exist that require skilled nursing facilities, long-term care hospitals, home health agencies and inpatient rehab facilities to collect and submit clinical performance data to Medicare. In October 2017 CMS began publicly publishing quality data, including readmission rates, for post-acute sectors.
Publication of 30-day readmission rates is just one of the newest moving parts PACs must monitor. Providers face several consequences to high readmission rates and failure to report quality measures that have financial implications:
- Losing coveted hospital referrals, as hospitals won’t send patients to underperforming PACs.
- A loss of patient referrals who may consider publicly available readmission data to make decisions about where to receive post-acute care.
- Beginning Oct. 1, 2018, value-based purchasing (VBP) requirements kick in for some PACs. Providers who are meeting guidelines may be incentivized, while providers not meeting quality care and reporting requirements may be subject to a 2% reduction in Medicare payments.
PACs must begin relying more on key data and metrics to reduce readmission rates. It’s never been more important to invest in platforms that continuously measure and report on quality levels, and those technologies that deliver live updates on patient progress. Also critical are revenue cycle management solutions that provide invaluable insight into billing. This includes tools that offer advanced reporting on post-acute Medicare claims throughout the entire reimbursement cycle, including reports that monitor readmission dates.