Payment Overhauls to Bring SNFs, Home Health Providers Closer Together

Similar to home health providers facing the Patient-Driven Groupings Model (PDGM), skilled nursing facility (SNF) operators are months away from a major payment overhaul themselves.

Effective beginning Oct. 1, the Patient-Driven Payment Model (PDPM) should trigger more collaboration between the SNF and home health worlds — at least in theory.

Understandably, the two complex models are inherently different. The overriding commonality, however, is the tighter alignment of payment by the Centers for Medicare & Medicaid Services (CMS) to the medical complexity of patients.

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“I think [they’re both] really part of the broader view of what CMS is doing as far as innovation, lowering the cost of care across the continuum and improving the quality of care that we provide to our seniors in this country,” Erin Shvetzoff Hennessey, CEO of Health Dimensions Group, recently said during a panel discussion at the 2019 Skilled Nursing News Summit in Chicago. “That has to include integration and communication.”

Minneapolis-based Health Dimensions Group is a a privately held company that provides consulting and management services to post-acute, long-term care and senior living providers, as well as hospitals and health systems across the U.S.

In general, PDPM is meant to more accurately reimburse SNFs for the clinical care provided to patients and simplify the overall payment process, according to CMS.

In-line with PDGM, PDPM is also supposed to lessen financial incentives for the over-delivery of therapy services.

“As [SNFs] move downstream, there should be control over who you’re handing these patients to,” Shvetzoff Hennessey said. “We need to make sure who we hand these patients to have the same incentives that we do, which is to provide high-quality, lower-cost care. I think that’s really the direction … CMS is going. They’re encouraging us to collaborate, work together and streamline our services.”

Aaron Tripp, LeadingAge’s vice president for reimbursement and financing policy, echoed those sentiments. Tripp joined Shvetzoff Hennessey on the Skilled Nursing New Summit panel, along with Vincent Federle, partner and director of analytics at Zimmet Healthcare Services.

“Really, the foundation of PDPM is very similar to PDGM — and is also similar to the conversations that are going on around a potential unified post-acute payment system that could come out in the future,” Tripp said at the event. “We need to be talking to each other as a continuum of care — not just in our own four walls.”

Washington, D.C.-based LeadingAge is a nonprofit advocacy organization that represents a wide variety of aging services providers.

Currently, Medicare uses distinctive payment systems to pay for stays across the post-acute care landscape, made up of SNFs, home health agencies, in-patient rehabilitation facilities (IRfs) and long-term care hospitals (LTCHs).

But MedPAC has long been considering how a unified post-acute care payment system would work.

While Shvetzoff Hennessey and Tripp believe PDGM and PDPM will likely lead to more collaboration between the SNF and home health industries, Federle said closer relationships won’t develop in earnest until SNF operators are exposed to greater risk-taking opportunities.

“With respect to aligned incentive, specifically financial incentive, we’re not taking risk. The SNF has been largely shut out of risk-taking, especially on the short term side,” Federle said. “I think it’s a good sound bite to talk about the downstream collaboration between home health and SNFs, but I’d like to see more incentive placed by CMS on us.”

Morganville, New Jersey-based Zimmet Healthcare Services Group is a full-service consulting firm focused on developing innovative solutions to the challenges of operating in the post-acute care space.

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