Value-Based
Quality and
Payment
Initiatives in Skilled Nursing Facilities
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Clifton Porter II, LNHA
Senior Vice President, Government Relations
American Health Care Association
VBP Movement: Administration
• “We are setting clear goals—and establishing a clear timeline—for
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moving from volume to value in Medicare payments”
“Our first goal is for 30% of all Medicare provider payments to be
alternative payment models that are tied to how well providers
care for their patients, instead of how much care they provide—
and to do it by 2016. Our goal would then be to get to 50% by
2018.
“Our second goal is for virtually all Medicare fee-for-service
payments to be tied to quality and value; at least 85% in 2016 and
90% in 2018”
– Sylvia Matthews Burwell, HHS Secretary, Jan. 26, 2015
Policy in Direction of VBP Plans
ACA contains extensive
and broad provisions for
VBP transition
Deference to Center for
Medicare & Medicaid
Innovation
Recent CMS proposed
rule on hospital bundling
demo with quality
component
IMPACT Act significant
step forward in tracking
and coordinating PAC
services—begins reported
tracking in 2018
State Medicaid valuebased plans: Ohio, New
York, Indiana, Colorado
Private Sector Efforts
• Value-based insurance design being adopted by multiple
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insurance providers
2008 study by the American Journal of Managed Care
estimated 20-30% of large employers use value-based
strategies
“CVS Caremark Pharmaceutical Benefit ManagementPositive Results for value-Based Insurance Design Plans”
Health Affairs, Feb 12, 2014
AHCA Efforts
Readmissions Value Based Program
Incentivizes SNFs
to reduce
avoidable
readmissions by
rewarding good
performers
Saves $2 billion
over ten years
Secretary must
establish a scoring
and ranking system
based on current
readmission
standard
Some SNFs will
make more money,
40% will get less
than they
otherwise would
have
Preliminary AHCA Effort
• Our Payment Reform Idea
o Contains VBP provision—shifts SNFs away from pure volume
payment
o Based on AHCA Quality Initiative, started in 2012, specifically
reducing hospital readmissions
o Medicare per diem payments eliminated in favor of SNF-only
bundled payments, which include all current SNF services.
o Saves $3.8 billion
How do Providers Move
Forward?
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Focus: RRV
• Rate
o Protect our rate and ensure predictable and reasonable
increases
• Regulation
o Combat duplicitous and costly regulations
• Volume
o Advance policies that acknowledges our value proposition and
places patients in the correct settings based on their needs
VBP Lowering Length of Stay
Length of stay
Present Norm
Value-Based
Purchasing
Defined, smaller stays
In VBP System
RRV as Applied to VBP
• Rate: controlling cost for quality outcomes vs. what would
have been paid on per-day FFS, managing costs from labor
perspective
• Regulation: determining measures: risk adjustment,
geographic, socioeconomic, setting
• Volume: ensuring shorter stay doesn’t mean fewer beds
filled. How do SNFs stay at capacity while decreasing the
amount of time patients stay there? Ability of SNFs to expand
capacity in a way that increases volume of patients serves for
shorted period of time
How to Measure Outcomes
Quality over process
• It’s not enough to
get somebody out
fast, they also need
to be healthy and
achieve goals.
Underscores the
importance of
reliable and available
quality data.
Break down silos
• Evaluating a patient
as the pass through
the entire spectrum
of care rather than
setting-by-setting
Finding the sweet spot
• Shared savings only
possible when we
have a good idea of
how much time a
patient needs in
each setting
Creating an Infrastructure
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Clear, developed networks between care providers
Effective transitions of patients between care settings
Shared information (e.g. HIT) and resources (e.g. physician)
Necessary follow-up: ensure patients are doing what they
need to do to fully recover
o “the long-term services and supports ‘marketplace’ lacks innovative
solutions for supporting frail older adults in a traditional home
setting” –Anne Tumlinson, Health Affairs, 11/20/14
o Significant opportunity for data analytics and mobile IT in homes of
recovering patients
How to Succeed?
Successful SNFs in the VBP world will…
Take initiative to create, track, and measure key quality metrics and outcomes,
both mandated and voluntarily
Forge relationships with providers at all points in the spectrum of care.
Forge relationships with the patient community and provide follow up even
after care is delivered
Thoroughly exceed customer experience expectations
Questions and Comments