Bundled Payments and Nursing Home Services Case Study Discussion

Bb Assignments – SERVICES AND HC X S Ask a new question – Studypool X VitalSource Bookshelf: Dimensior X + 1 C https://bookshelf.vitalsource.com/#/books/9781567938371/cfi/6/24/4/2/258/20@0:4.69 10. How can LTSS efforts to reduce rehospitalization and overall Medicare expenses best be explained to the American public? C CASE STUDY: BUNDLED PAYMENTS AND NURSING HOME SERVICES THE NEW FRONTIER = As the administrator of a large, 240-bed, privately held, nonprofit nursing and rehabilitation care facility with a designated dementia unit, you have been approached by an area hospital, from which you receive most of your skilled nursing patient referrals, about joining its accountable care organization. Communication between your director of admissions and the hospital discharge coordinator for incoming Medicare skilled nursing facility (SNF) residents has been difficult at times, especially in terms of establishing immediate SNF care needs such as medications and therapy plans; however, your facility has benefited from the partnership and has confidence in the hospital overall. In order to participate in the ACO, you will have to agree to bundled payments for some episodes of care for which you provide rehabilitation services, and you will have to develop on-site home health services that are put in place immediately after a patient’s discharge from the skilled nursing facility to home. You are also aware that, by joining the network, you will receive payment incentives for assisting the ACO in achieving good outcomes but may incur reimbursement losses if you are unable to meet either SNF or home health quality benchmarks. In the past three years, your overall rehospitalization rate has hovered on par with the state average, but it is lower than direct competitors in your immediate area. To achieve desired outcomes, rehospitalization rates would have to drop another percent over the next year, and 10 percent over the next five years. Joining the ACO would better position you and your organization to meet broader

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healthcare reform requirements while modernizing the services you provide, thereby improving your place in the market. However, it would also require substantial investment in risk management, personnel, and staff training as well as new investments from company holdings for providing home care services that could facilitate smooth care transitions across the ACO. You’re convinced that the plan represents the direction of the future and is what’s best for your population, but you must convince your board of directors of the plan’s value. Key to winning the board’s support will be your ability to explain why combining SNF services with LTSS is a necessary next step to strengthening your organization’s position in the new healthcare environment in the era of the ACA CASE STUDY QUESTIONS 1. Considering the growing emphasis on care coordination, care transitions, and community-based LTSS, describe both potential opportunities and threats associated with joining the ACO. 2. Assume that you and your organization have decided to join the ACO. What will you do to begin lowering your hospitalization rates to meet ACO reimbursement goals for best practices? 3. Assume that you are in the process of negotiating your role in the ACO. What recommendations will you propose to the hospital in terms of care transitions? For example, should you try to enroll only eligible Medicare beneficiaries with a few select chronic conditions, or should you target all diagnoses eligible for bundled payments? How will your answer affect hiring, training and retaining staff? REFERENCES Administration for Community Living (ACL). 2016. “Administration on Aging (A0A) and the Older Americans Act.” Accessed February 26. www.aoa.gov/A0A_programs OAA 2015. “Aging & Disability Resource Centers Program No Wrong Door System.” Updated October 8. www.acl.gov/Programs CIP OCASD ADRC/index.aspx. 2013. “ACL Strategic Plan 2013-2018.” Accessed April 1, 2016. www.acl.gov/About_ACL StrategicPlan docs/ACL_Strategic Plan.pdf Advancing Excellence in Long-Term Care Collaborative. 2015. “Advancing Excellence in Long-Term Care Collaborative.” Accessed February 26, 2016. www.aeltcc.org. Altman, S., and D. Shactman. 2011. Power. Politics, and Universal Health Care: The Inside Story of a Century-Long Battle. Amherst, NY: Prometheus Books. Americans with Disabilities Act (ADA) National Network. 2016. “What is the Americans with Disabilities Act (ADA)?” Accessed February 26. ht