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Valued-based purchasing is coming to long-term care facilities nationwide—and it’ll be here before you know it.
This payment model is designed to support the practice of resident-centered care—which many long-term care facilities have already implemented to some degree. Still, in an industry with deep traditional roots, particularly in regard to reimbursements, the shift in payment model may be jarring—and preparing for the change may be overwhelming.
But it doesn’t need to be.
With the help of a few tools and a little advance planning, you can help make your facility’s transition to value-based care a simple one.
“It's important that we stay ahead of the curve, and that's always a challenge,” says Michelle Bulger.
Bulger, alongside Patty Embree, vice president of innovation at Vincentian Collaborative System, will be co-instructing a conference session at the 2018 AADNS annual conference in National Harbor, MD, on this very subject. The June 29 session, called “Making the Move to Value-Based Care,” will shed light on practical, actionable steps and tools you can implement within your own facility today to prepare for this coming change.
The Centers for Medicare & Medicaid Services (CMS) has contracted with RTI International and Abt Associates to develop cross-setting post-acute care transfer of health information and care preferences quality measures in alignment with the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). As part of its measure development process, CMS requests interested parties to submit comments on two draft measure specifications:
The call for public comment period closes on May 3, 2018.
On May 4, 2017, the Centers for Medicare & Medicaid Services (CMS) issued an Advance Notice of Proposed Rule-making (ANPRM) to solicit public comments on potentially replacing the existing therapy-driven Resource Utilization Groups, version 4 (RUG-IV) case-mix methodology for the skilled nursing facility prospective payment system (SNF PPS) with a nursing-driven Resident Classification System, version I (RCS-I). The ANPRM set off a firestorm of misinformation about when RCS-I would be implemented and exactly what it would look like, with some industry insiders predicting a finalized RCS-I could implement as early as Oct. 1, 2018 (i.e., for fiscal year 2019).
The Centers for Medicare & Medicaid Services (CMS) has contracted with the RAND Corporation to develop standardized assessment-based data elements to meet the requirements as set forth under the IMPACT Act of 2014. CMS also has contracted with RTI International and Abt Associates to develop cross-setting post-acute care transfer of health information and care preferences quality measures in alignment with the IMPACT Act.
Historically, many providers have treated the MDS and the Resident Assessment Instrument (RAI) process as a silo of government-mandated busywork. That’s always been a problem because, since day 1, the primary purpose of the MDS has been to identify resident care problems that are addressed in an individualized care plan. However, the footprints of the MDS are now carved deep into multiple facets of facility life, including:
· The Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS);
· Some Medicare Advantage payment systems;
· Some Medicaid payment systems;
· The MDS-based quality measures (QMs) that are publicly reported on Nursing Home Compare and used in the Five Star Quality Rating System; and
· The MDS-based QMs that will be publicly reported under the Skilled Nursing Facility Quality Reporting Program (SNF QRP) beginning in October 2018 assuming ongoing data issues are resolved timely. Note: SNFs also must meet an MDS-based reporting threshold under the SNF QRP to avoid a SNF PPS payment penalty each fiscal year.
Last but not least, the new Long-term Care Survey Process (LTCSP) makes sure that surveyors have MDS-based clinical indicators to guide their investigations from the moment they walk in the door, according to the LTCSP Procedure Guide.
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