7 proven tips for nursing homes to increase referrals & revenue
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MEET THE AUTHOR: Norm R. Burns
In addition, he has extensive experience working with "distressed" organizations in turnaround and workout management, crisis management, and interim management.
Prior to launching the firm, Norm was Vice President, Human Resources at Northwestern Memorial Hospital where he was responsible for all human resource functions. He also held a similar position at Lindberg Corporation, overseeing all human resources and industrial relations for 22 plants on a corporate-wide basis. Norm has also held the top Human Resources position at Ingalls Memorial, a large community hospital.
Norm holds an M.S. degree in Human Resource Management from Loyola University in Chicago. He has been on the faculty of several Chicago universities, teaching courses in human resource management and labor-management relations at the graduate level.
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Norm is the founder and president of Organization Dimensions, Inc., a consulting firm specializing in assessing and improving organizational effectiveness, with an emphasis on human resource management, key organizational processes, and customer/patient satisfaction.
He has over 25 years of experience in industry and the entire healthcare continuum.
Introduction & Background…………………….1 The 7 Proven Tips..………………..……………..8 Conclusions………………………..………….…....25 The SNF Best Practices Guide………….….....27
TABLE OF CONTENTS:
Copyright © 2015 Organization Dimensions, Inc.
INTRODUCTION & BACKGROUND
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Four years ago, the Centers for Medicare & Medicaid Services (CMS) finalized the
Medicare Shared Savings Program (SSP), as authorized by the Patient Protection
and Affordable Care Act (Affordable Care Act) to help doctors, hospitals, and
associated health care providers to more effectively coordinate care for Medicare
patients via Accountable Care Organizations (ACOs).
ACOs are networks of health care and health service providers, including
physicians and hospitals, and other vendors involved in patient care, that agree to
work together to coordinate care for the Medicare Fee-For-Service patients they
serve. Health care providers that participate in an ACO are incentivized to work
as a team when treating patients across multiple care settings, from doctor’s
offices and hospitals, to long-term care facilities.
The Fee-For-Service payment system where providers receive different,
disconnected payments can lead to inefficient patient care. The main goal of an
ACO is to deliver high-quality, seamless care for Medicare beneficiaries.
Internally, ACOs will be responsible for coordinating care, maintaining a patient-
centered focus and developing processes to promote evidence-based medicine,
promote patient engagement, and then publicly report on quality and costs,
particularly cost savings.
INTRODUCTION & BACKGROUND
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With currently over 600 ACOs in all 50 U.S. states, ACOs continue to grow in
number and are expected to continue to develop throughout 2015. Existing ACOs
are also evolving in the development of approaches, tools, and techniques to
increase effectiveness and corresponding cost savings. The result will be the “Next
Generation ACO Model.” Bill Myers has written an article that refers to this as the
“NEXT Wave of ACO evolution gives providers a chance to be “Real Winners”
(Provider, 10/15/14).
The Affordable Care Act established the Medicare Shared Savings Program to:
• Promote accountability for a population of Medicare beneficiaries
• Improve coordination of care with a Patient-Centered Medical Home focus
• Encourage investment in infrastructure
• Redesign care processes
• Improve quality, efficiency and patient satisfaction
Copyright © 2015 Organization Dimensions, Inc. Page 3
7 Tips For Becoming an ACO Preferred Provider
2 in 3 Americans over 65 have multiple chronic conditions.
MULTIPLE = MULTIPLE = DISJOINTED conditions doctors care
7 Tips For Becoming an ACO Preferred Provider
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Nursing homes looking to join an ACO are most likely to need to make more effort
to stand out in what is a very competitive market. For example, n ACO may not be
willing to partner with an SNF that has a low quality rating or lacks an electronic
health records (EHRs) system. A s a recent commentary put it:
“In the ACO [world], one physician, one nursing home, or one hospital
participant in the ACO that performs poorly could affect the bottom line by
reducing the amount of the shared savings from the government.”
~ Chris Echterling, M.D.
The hope is that the benefits of inclusion in an ACO may motivate nursing home
administrators to further quality improvement efforts.
The Opportunity
Under MSSP, CMS will continue to pay providers under the payment system that
already applies to that provider. As a result, SNFs will continue to receive both
Medicare and Medicaid payments for services that they provide to residents.
However, the key difference is that participating providers are eligible to receive a
portion of any savings generated by the ACO. When ACO providers save CMS
money (measured against the target benchmark set by CMS), the ACO receives a
portion of those shared savings from CMS at the end of the year, and passes a
percentage on to the provider.
“Going it alone is not really viable today. If you're not part of an ACO, your patient base is probably going to shrivel up, at least on the Medicare side.” ~ John Durso
Skilled nursing facilities that delay joining an Accountable Care Organization will
likely be losers in the healthcare marketplace, according to John Durso, a partner
and senior member of the Healthcare Practice Group at the law firm of Ungaretti
& Harris LLP.
ACOs and similar models that coordinate acute and post-acute care are destined
to replace the current healthcare delivery system, Durso said, and nursing homes
will weaken their negotiating position with ACOs if they do not act fast, he
stressed.
7 Tips For Becoming an ACO Preferred Provider
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By negotiating now, long-term care providers can ensure they have a seat at the
table of the ACO, so they can influence decision making and not just play the role
of a subcontractor to the hospital and physician members, according to Durso.
Nursing homes can leverage their proximity to Medicare patients in negotiations
to join an ACO, he said. Post-acute providers that offer home care, dialysis and
rehabilitation therapy will have valuable chips in these negotiations.
“If you don't get in now, early, while they're in their formative stages, what they're going to do is come and offer you a contract in two to three years. And it's going to be, this is what it is, take it or leave it.” ~ John Durso
7 Tips For Becoming an ACO Preferred Provider
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1. Compliance with the new Centers
for Medicare & Medicaid Services
(CMS) quality-of-life requirements
2. Implementing resident satisfaction
initiatives
3. Achieving high levels of
satisfaction among the ever-
increasing short-term care
population
Many providers may resist the
changes that are taking place,
but forward thinking SNFs will
see the opportunities in joining
an ACO. However, the
competition to become a
preferred provider is steep.
The Long Term Care Industry has
many challenges ahead,
particularly in three areas that
are sure to impact bottom-line
results:
.
7 Tips For Becoming an ACO Preferred Provider
Copyright © 2015 Organization Dimensions, Inc. Page 7
7 TIPS FOR BECOMING AN ACO PREFERRED PROVIDER
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We invite you to take a look at the
“The SNF Best Practices Resource Manual”
The SNF Best Practices Guide
http://bit.ly/SNF-BPG