CMS’ Push For Value-Based Purchasing Could Bring Significant Changes for Operators

CMS’ push for value-based purchasing made big strides in 2016, and facility operators are paying attention.

Starting in 2019, CMS’ Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP) will be in full swing, and facilities will be paid based on the quality of their care, not just the quantity.

If they aren’t already, operators will soon be awash in the nitty-gritty details of this new payment paradigm. How should they think about these changes? And will the changes be beneficial for operators?

The former question was the topic of a panel discussion at the 2016 NIC Fall Conference, and several experts weighed in. From an NIC blog post:

David Gifford, American Health Care Association, acknowledged that a number of changes are occurring and that “the details can be overwhelming.” He pointed out that some common themes exist—and these are where operators should put their focus. Avoiding hospital utilization, not just rehospitalization, he said, is where the best operators are investing resources, along with building strong relationships with hospitals in their referral regions. Furthermore, Gifford maintained that while rehospitalization is an important metric, operators must be aware that it takes time before that metric responds to investments in quality.


When asked what strategies and areas of focus operators are employing to adapt to the changing environment, all panelists echoed what Thivierge said earlier in the presentation: that the transition to value-based purchasing is inevitable. Nanci Wilson, Plum HealthCare Group, said, “You can’t sit and wait . . . If we aren’t looking five years ahead, you’re going to be left at the train station.”

Another important point: 2019 is coming sooner than you think. From the blog post:

The panelists also noted that to adjust to the new paradigm, operators need a culture shift, especially when it comes to risk management. Dr. Gifford said that many operators are expressing that “2019 is so far away,” but in reality, the shift in operator perspective needs to happen now. Jason Feuerman, of Genesis HealthCare, has experience managing risk through a Medicare Advantage plan. He said that he believes that when providers have financial incentives and data, “quality and outcomes and savings will come from that.” As Farr stated, “we are people caring for people, and so by definition, we are at risk. But how to you manage that risk?”

The experts agreed that the changes will be beneficial for patients.

And, at another panel discussion last week, experts expounded on how the changes will be good for senior living industry, as well.

During the panel discussion at last week’s 2016 PointClickCare SUMMIT, one word kept getting repeated: reputation. That’s where the true return on investment may lie.

From Senior Housing News:

So, what’s the payoff for putting all of this effort into doing well in patient-centered, value-based care? A bolstered reputation and likely even a better return on investment, the executives agreed.

“The return is our reputation,” Dillane said. “We believe on a long-term basis that’s just going to make us the home of choice.”

Katzmann agreed, noting that Juniper’s embrace of value-based care has resulted in cutting-edge programs and a flexibility that sets it apart from other providers.

“Reputation is everything, especailly when you’re a smaller company.” she said.

Plus, if providers have all sorts of services residents need on-site—pharmacy, labs, primary care, home health care—they can keep residents healthier, for longer periods of time. Healthier residents have longer lengths of stay, and length of stay directly impacts a provider’s return on investment, Katzmann said.


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