Skilled Nursing Facilities – Medicare Changes and Proactive Management, the Mantra for FY2018

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule (CMS-1622-P) on April 15, 2015, outlining the proposed Medicare payment rates for skilled nursing facilities (SNFs) for the fiscal year 2016. The overarching principle behind these rules changes is the general objective of a drive to shift Medicare payments from volume to value.

The understanding of the authority is this – healthcare in our country needs to move from paying providers for the quantity of services to the quality of care they provide to patients. The purpose behind this is the idea that doing so would mean that the health care system will be provided the right incentives to move towards delivering better care to patients while being more efficient and spending less health care dollars. This combination is likely to bring patients greater value and lead to healthier and happier people.

The biggest change in the compliance framework for 2018 is the quality reporting program that have been put into place. Skilled Nursing Facilities will have to implement a quality reporting program in accordance with the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), or else they will have their annual updates reduced by 2 percent. The proposed measures being considered by the CMS look at three broad domains, as identified in the IMPACT Act –

 

  • Skin integrity and changes in the skin integrity of patients

This parameter will consider the percentage of Residents or Patients who have pressure ulcers that are new or have become worse.

  • Incidences of major falls within the SNF

This parameter shall look into the application of the percentage of Residents who have experienced one or more falls with major injury for the duration of their stay.

  • The functional status, cognitive functions, and the changes thereto over time

This parameter shall look into the percentage of Patients or Residents who have had an admission and discharge functional assessment, with a care plan that directly addresses function.

 

With CMS showing a new focus on SNFs, it is incredibly important for such facilities to begin the process of bringing their systems in accordance with the upcoming regulatory requirements. Quality reporting and the associated documentation and processes for the personnel of the SNFs requires some expertise in quality reporting and understanding the CMS’ regulatory framework.

To understand what Medicare changes are on the horizon for FY 2018 and how SNFs need to prepare for these changes, I recommend you attend this live webinar on SNF Medicare Changes by expert speaker, Keri Hart, MS, CCC-SLP, CHHRP-QT, RAC-CT. Keri is a CHHRP (Certified Harmony Healthcare Rehab Professional) Qualified Trainer providing certification training for Rehabilitation and Nursing professionals as well as on-site auditing of medical records.

 

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