2017 AHC/NCAL Annual Convention & Expo
Improving Your Five Star Rating by Disrupting the Status Quo in Post-Acute and Long Term Care
PAC and LTC operators are increasingly squeezed between decreasing reimbursements and increasing costs of care, while clinical practice models have not changed in decades. Part of the challenge stems from a lack of risk assessment and evidence-based management tools for the most clinically vulnerable and costliest resident population. As recent CMS changes create pressures to move away from a volume-based model to a quality and value-based model, centers are seeing fewer traditional post-operative rehabilitation residents and more who are medically complex and frail. We will address these pain points and present several case studies where state-of-the art software and data analytics unlocked the potential value of centers’ own data to improve outcomes and their Medicare Star rating, while decreasing readmission and utilization costs.
We present an approach to long term and post-acute care that begins with an evidence-based pre-admission assessment tool that collects all pertinent admission information and generates an initial care plan based on the risk of vulnerability associated with frailty. Knowing the degree of vulnerability to adverse outcomes at the time of admission allows necessary preparations to be made before admission, and it prompts clinicians to complete the admission examination keeping in mind risk and the likelihood of hospital readmission if residents and families do not communicate with the clinicians as early as possible. After admission, MDS data is routinely processed for analyzing and reporting, in real time, all outcome measures triggered, vulnerability and re-admission risks, clinical decision support recommendations, and multiple domain assessments important for proactive rather than reactive care. Having access to real-time MDS data gives authorized professionals access to all reports for focused QA, root-cause analysis, and multiple co-owned centers summaries. Case studies with measurable results will be presented.
Learning Objectives:
- Discuss the impact of clinical vulnerability from frailty as it applies to quality and value
- Measure the potential value of facility's MDS data on quality outcome measures, re-admissions, and reimbursement
- Identify the ways in which routine data collection impacts your Medicare star ratings
Steven Buslovich, MD, MSHCPM
Medical Director and Geriatrician
Team HealthDisclosures: Patient Pattern, Inc: Ownership Interest (stocks, stock options, or other ownership interest excluding diversified mutual funds)
Margaret Sayers, MS, NP
Geriatric Nurse Practitioner
Patient Pattern, Inc.Disclosures: Patient Pattern, Inc: Ownership Interest (stocks, stock options, or other ownership interest excluding diversified mutual funds)
Eugene Gonsiorek, PhD
VP of Post-Acute and Long-Term Care
Kaleida HealthDisclosures: Nothing to disclose