The old fee-for-service model of healthcare payment is on its way out. In fact, as early as 2019, the Centers for Medicare and Medicaid Services (CMS) plan to launch the Skilled Nursing Facility Value-Based Payment Program (SNFVBP). In this post, we’ll explore exactly what that means and how it applies to skilled nursing providers.
From Quantity to Quality: The Shift to Value-Based Care
As you know, the old fee-for-service model is driven by the quantity of healthcare services provided. For example, payment under this system is determined by the number of tests you order or the sheer volume of procedures your skilled nursing facility performs.
The new value-based payment approach, however, is more concerned with the quality of the care itself. In other words, does the care you offer as a skilled nursing provider actually improve quality of life for your patients?
Of course, this brings up an interesting question: How is quality defined and measured under a value-based care model?
Measuring Quality of Care in a Value-Based Payment Model
There are several key performance indicators (KPIs) that skilled nursing providers should start to consider as the SNFVBP launch date approaches. A few of these KPIs include:
- Cost of Care – This is the total cost of caring for a given patient. Cost of care is risk-adjusted and measured on a per-patient, per-month basis. Your skilled nursing facility can reduce cost of care by cutting back on redundant tests or by implementing a generic drug prescription initiative.
- Readmission Rate – Unplanned readmissions can hurt your quality scores. A robust clinical software solution can help skilled nursing providers deliver superior outcomes and reduce readmissions. Note: planned readmissions are not considered a measure of quality.
- Patient Access & Operational Effectiveness – Today more than ever, patients demand easy access to care. Skilled nursing providers must maximize operational efficiency to reduce wait times, increasing capacity if necessary.
- Patient Satisfaction – The Leapfrog Group, Yelp, Healthgrades…Patients have access to countless outlets for rating their satisfaction with your skilled nursing facility. This is where customer service plays a critical role in maintaining a high quality score.
Multiple Value-Based Care Models, One Common Purpose
All value-based care models are centered on the patient. Healthcare providers receive payment when their overall quality of care meets the standards set by the CMS. The primary objective of a value-based approach is to provide patients with better care, leading to better health and, ultimately, lower healthcare costs. Some of the currently active value-based models are:
- Patient-Centered Medical Home (PCMH)
- Accountable Care Organization (ACO)
- Pay for Performance (P4P)
- Bundled Payments
Prepare Your Skilled Nursing Facility with a Clinical & Resident Management Solution
MatrixCare Clinical and Resident Management, optimized specifically for skilled nursing providers, can help you deliver the best possible care to your residents while improving your CMS quality measures and maximizing reimbursement under the upcoming Skilled Nursing Facility Value-Based Payment Program. For more information about our solutions for skilled nursing providers, including our Revenue Cycle Management solution, contact us today.