The Centers for Medicare & Medicaid Services (CMS) SNF Value-Based Purchasing (VBP) Program aims to reward quality and improve health care by reducing hospital readmissions from skilled nursing homes. Starting in FY 2019, SNF VBP began to apply incentives and penalties to Medicare reimbursement payments. VBP establishes a hospital readmissions reduction program for providers, encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers and payment penalties for under-performers.
According to the Robert Wood Johnson Foundation, 4.4 million hospital readmissions account for $30 billion cost to Medicare every year and 20% of Medicare patients are expected to return to the hospital within 30 days of discharge. The Congressional Budget Office estimated VBP to save Medicare $2 billion over the next 10 years.
What are the Main Causes of Readmissions?
A study conducted by the Agency for Healthcare Research and Quality (AHRQ) on readmissions from 2011 identified congestive heart failure as the top cause of readmissions among Medicare patients, followed by septicemia, pneumonia, COPD and cardiac dysrhythmias. Other top reasons for readmissions included: adverse drug effects (ADE), lack of proper follow-up care/lack of follow-up with the physician after discharge, inability of patients to understand the importance of their medications and diagnoses, unidentified root causes and misdiagnosis.
While hospital readmissions can be a drain on Skilled Nursing Facilities bank accounts, there is also an upside: top performers under VBP can avoid any penalty and can achieve an even higher bonus payment than was previously available.
What Can Blue Sky do to Help Increase Payments under VBP?
Blue Sky Therapy Strategies to Reduce Hospital Readmissions:
- Care pathways designed to identify and prevent potentially preventable conditions with diagnosis-specific and customized treatment protocols:
- Congestive Heart Failure:
- Blue Sky’s Cardiac Program has extensive protocols that monitor patient vitals, review perceived rates of exertion (PRE), edema, etc. that help to identify if the resident is having issues that require further attention. Therapists communicate extensively with nursing if any concerns are noticed.
- Blue Sky’s Medical Management clinical pathway provides guidelines about multiple risk factors to assess, to monitor, and to identify if patient is experiencing a decline, other issues, reports of not feeling well, etc. and relay that information to nursing.
- This collaborative approach allows the care team to be proactive in preventing further complications.
- Blue Sky’s Pulmonary Program helps decrease the risk of respiratory symptoms and complications by encouraging self-management and control over daily functions.
- If there is a noted decrease in function, therapists can alert nursing of the decline and identify steps can be taken to eliminate hospital readmission.
- Congestive Heart Failure:
- Therapists have extensive education regarding diagnoses, monitoring vitals/oxygen levels, understanding the precautions of patients' conditions, monitoring sodium levels (CHF), etc. which makes therapists a key resource in determining follow-up care that is needed and providing appropriate patient/family education.
- Proactive discharge planning: Blue Sky therapists help to ensure a smooth, safe transition to home or to lower level of care with appropriate services in place to avoid lack of a proper follow-up care.
- Post-discharge follow-up: Blue Sky Rehab Managers provide this service and follow-up with patients after discharging home.
- Blue Sky uses data analysis and metrics that focus on re-admission statistics to collaborate with our partners on implementing data-driven facility initiatives to reduce hospital readmissions.
Learn more about where your facility ranks under VBP.