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How to align resources for post-acute care

August 20, 2014
by Jim Bowe
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Reward quality outcomes and control costs
Jim Bowe

Editor’s note: This is the first report in a two-part series on post-acute care strategies and tactics.

Every segment, every niche across the nation’s entire healthcare delivery system during the past several years has been inundated by an unprecedented wave of radical, disruptive transformation.

Fundamentals driving clinically integrated care networks

Clinically integrated care networks are rapidly spreading to enable seamless transitions between physicians, hospitals, rehab and skilled nursing providers, and community-based services. These risk-based, pay-for-performance reimbursement models have emerged:

  • Accountable care organizations. Typically pool 5,000 lives or more in a population health/wellness management model funded by an annual per capita fee that covers the costs of virtually all services across the care continuum.
  • Bundled payment. Providers bear risk under a flat rate structure that reimburses for entire episodes of care by dividing the fee among pertinent service providers across the care continuum.

With the emergence of risk-based, pay-for-performance reimbursement models such as accountable care organizations and bundled payment, clinically integrated care networks are rapidly spreading to answer the need for the seamless coordination of transitions between physicians, hospitals, rehab and skilled nursing providers, and community-based services. The fragmented delivery systems predicated on the economics of volume-driven, fee-for-service procedures are giving way to a broader, holistic approach that uses clinical care pathways to comprehensively, cost-effectively manage entire episodes of care throughout multiple care delivery sites.

So how does a post-acute care (PAC) operator take advantage of these seismic changes and get in the game?

Data-driven metrics

The key to forging partnerships is developing data-driven metrics that track outcomes to validate a PAC operator’s qualifications and measure its ongoing performance. At the same time, PAC organizations also must analyze Medicare-related trends at their referring hospitals to identify opportunities for performance improvement that their acute care counterparts may have overlooked. By drilling into the performance data from the PAC operator and the analysis of hospital Medicare trends, both groups can jointly move forward to develop partnership strategies to improve outcomes, increase efficiency, reduce costs and enhance throughput/access.

The ability to consistently track and analyze a wide range of outcome and performance metrics in post-acute care depends, in large part, on software and information technology capabilities. Ongoing data input from a multidisciplinary team is crucial.

Basic PAC quality indicators address pressure ulcers, urinary tract infections, weight loss, falls, fractures, decline in activities of daily living and restraints. The Medicare Nursing Home Compare five-star ratings also are a routine point of reference.

For short-term, post-acute rehab stays, each admission should be categorized according to payer source, admission and discharge dates, length of stay, diagnosis category and site of relocation following the rehab stay. Discharge data are required to gauge whether transitions from post-acute care back to the community have been successful.

Measuring rehab functional gains outcomes, along with rehab therapy performance, is critical. And members of the clinically integrated care networks will monitor the PAC clients’ satisfaction scores.

Keys to successful partnerships

Post-acute care organizations and hospitals should aim for success in the following:

  • Quality outcomes
  • Clinical care pathways
  • Length of stays
  • Readmissions performance
  • Electronic health records interfaces
  • Physician integration
  • Cost-tracking per episode
  • Post-discharge management
  • Patient/resident satisfaction

Timely length-of-stay transitions are a focal point under the pay-for-performance paradigm. To determine whether a provider is efficiently managing length of stays and following the clinical care pathway program, individuals should be classified according to diagnosis category to provide more specific medical profile breakouts. These categories may include:

  • Post-surgery recuperation,
  • Orthopedic recovery,
  • Fractures,
  • Stroke,
  • Cardiac rehabilitation,
  • Pulmonary rehabilitation,
  • Complex wound care,
  • Palliative care,
  • Oncology and
  • Medically complex.

Hospital utilization

Controlling hospital utilization is paramount to successfully participating in a partnership. Doing so requires a continuous evaluation of historic emergency department admission trends to identify condition/reason, date and shift, and length of PAC stay prior to hospital admission.