A newly proposed bundled payment model is likely to be making its way to certain areas of the country next year. The new model is centered on the care provided to cardiac patients after they leave the hospital. This means home health and skilled nursing facilities are both front and center.
The new cardiac care model is similar to the Comprehensive Joint Replacement (CJR) model being implemented next year across the country. Similar to the CJR model, hospitals will be sharing the risk of a patient being readmitted to a hospital for reasons related to cardiac procedures with providers who treat the patient after discharge.
The proposed rule would start on July 1, 2017 in 99 selected areas (CBSA codes). Two procedures would be part of the new model: coronary bypass surgeries and heart attack treatments. A 90-day episode of care would be the time basis for a bundled payment.
What will this mean for your agency? A couple things:
- Your CMS Home Health Compare Star Rating – Are you a 1, 2, 3, 4, or 5? Agencies that are 4s and 5s are going to be the ones selected to participate in the preferred provider network. Agencies that are selected to participate will have been able to prove their clinical excellence by demonstrating consistently high quality ratings. A 4 or 5-star agency is considered the best of the best. For an agency who doesn’t have these ratings, partnering with hospitals in affected areas are going to find it tough to receive referrals.
- Innovation – Adding cardiac programs to your agency will only enhance the ability to partner with hospitals in your area. Even if your agency is not in the selected areas for the demonstration, having up to date clinical programs and knowledge will only help your agency.
Staying at the forefront and becoming a resource rather than just an associated provider creates a much better image for your agency. As a resource, your agency’s overall value to the community is enhanced and allows for better relationships with other post-acute providers such as skilled nursing facilities and rehab facilities. Relationships besides the hospital will be key to securing more referrals.
This latest demonstration clearly indicates that data is securely driving healthcare – whether a hospital, a SNF or a home health agency like yours, data is in the driver’s seat. Your agency can’t escape the data and if the data isn’t on your side, you will have a tough time growing and even surviving.
How do you get to become a 4 or 5-star agency? Education, quality control and patience. It will take some time to educate your staff and it will also take some time to properly get your QA process in place. If your agency doesn’t have a dedicated QA member working on your behalf to make sure the agency is properly scoring OASIS, then you need to make this a priority. A well trained and knowledgeable QA person not only pays for themselves in terms of better revenue, but by monitoring, analyzing and improving the outcomes of your patients. Focus on results – not on quick fixes and your agency’s quality and outcome will speak for themselves!