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ACO Partnerships and Medicare Shared Savings: What's in It for SNFs?

September 16, 2019
Reimbursement By Rodney Farley, Director

The Medicare Shared Saving Program (MSSP) was established by the passage of the Patient Protection and Affordable Care Act (PPACA) as a new approach to delivery of health care. The goal of this program is to facilitate coordination and cooperation among providers, and to improve quality and reduce unnecessary costs. The MSSP is to be delivered through an Accountable Care Organization (ACO).

 

Medicine doctor hand working with modern computer and digital tablet computer and medical diagram with his team on wooden desk as medical concept

 

In addition to the MSSP, the passage of the PPACA led to the creation of the Center for Medicare & Medicaid (CMS) Innovation Center. This program supports the development and testing of innovative healthcare service delivery and payment models.

Proper collection and reliability of data is critical as many of the new payment models, including the MSSP, are data driven and the collaboration and partnering of providers is based on data driven key metrics and measures.

Per the CMS, eligible ACO providers and suppliers that may participate in the MSSP include:

  • ACO professionals in group practice arrangements
  • Networks of individual practices of ACO professionals
  • Partnerships or joint venture arrangements between hospitals and ACO professionals
  • Hospitals employing ACO professionals
  • Critical Access Hospitals that bill under Method II
  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Teaching hospitals that receive payment on a reasonable cost basis for the direct medical and surgical services of their physicians

What’s in It for Skilled Nursing Facilities (SNFs)?

Although relationships between ACOs and SNFs haven’t always been easy, it’s vital the two come together to provide effective post-acute care for beneficiaries. With the onset of new payment models, ACOs are creating preferred networks of SNFs—utilizing data obtained from CMS’ Five Star Quality Rating System, Nursing Home Compare, and other data submitted by the SNF—to evaluate potential partners.

To remain competitive, SNFs will need to collect, analyze and effectively present their key performance metrics.. In addition to helping the organization understand their business and make better management decisions, this will help drive the conversations with potential ACO partners and provide evidence of high quality of care, low cost and favorable outcomes.

As care delivery and payment models continue to evolve, the reliance on data will increase and the data analysis through measures and metrics will be the tool to prove organizational value.

The different programs and payment models, designed to reduce cost of providing care and increase quality of care, will rely on data to:

  • Improve quality measure data points and validate lower costs
  • Track metrics such as hospital readmissions, survey deficiencies, MDS outcomes and staffing

Providing accurate and timely data to analyze and implement is a key strategy. The main issues of quality of care and outcomes, accuracy of coding and claims should be the focus when gathering and tracking data for:

  • Payroll-Based Journal
  • Quality Assurance Performance Improvement
  • Billing claims

The current healthcare landscape is changing at a frantic pace and is challenging for all providers. A focused approach with ACOs is crucial. Healthcare providers collaborate to share similar goals such as reducing duplication of services, preventing unnecessary readmissions and ensuring care coordination.

When talking with ACOs, the data is a key area to highlight. However, the data only supports, or should support, the underlying organizational systems, procedures and protocols. Sharing insight into your SNF’s organizational capabilities can influence an ACO’s decision of whether or not collaboration and establishing a partnership would be fruitful; and most importantly, support cost-effective and high quality patient outcomes.

For help with coding accuracy, improving your facility’s Five Star Rating, or accurate and timely submissions of PBJ data, contact Rodney Farley, Director, by calling 717-213-3123 or email RFarley@LW-Consult.com.

 

Ask how LW Consulting, Inc. can help position your SNF as a preferred provider with ACOs.

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