On March 23, 2010, President Obama signed into law the healthcare reform bill, the Patient Protection and Affordable Care Act (PPACA). This legislation, along with the Health Care and Education Reconciliation Act of 2010, makes sweeping changes to the U.S. health care system. The bill contains 906 pages of legal instructions, but the most-talked-about provision of the law, Accountable Care, covering a mere 7 pages, will have a dramatic effect on care providers and should go into effect in 2012.  All providers are scrambling to comprehend the law and how the interpretation of the law will be implemented.

The Obama administration’s guidelines on how ACOs will work is some ways is quite simple: An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. Under the new law, an ACO would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

PPACA is upon us, and one only needs to pick up a newspaper or listen to the news to hear of the controversy surrounding the bill.  Regardless of the concern, PPACA is most likely here to stay, and it will indeed take an act of Congress to repeal and/or reform this new legislation.   There are still a lot of unknowns, but one thing is for certain: this piece of legislation has the potential to change care delivery and reimbursement as we know them today.  The ACO philosophy supports the premise that quality care can be provided at an affordable cost. Most healthcare organizations will not be an active participant in setting up the ACO but will have to provide their care and services within the confines of the new guidelines.

Section 3022 of the Patient Protection and Affordable Care Act (PPACA) creates the Medicare Shared Savings program, allowing ACOs to contract with Medicare by January 2012. The speculation is that hospitals and physicians will develop the ACO, bringing together the different parts of care for the patient — primary care specialists, other hospitals,  Skilled Nursing Facilities (SNF), Home Health Agencies (HHA), Assisted Living Facilities (ALF) and a wide variety of support-type businesses — and ensure that all of the “parts work well together.” The hospital or physician’s ability to mitigate shared losses is driven, in many instances, by the type of care the patient receives and the outcomes in a post-acute-care setting. This is strongly driven by the SNF, HHA and the activities of the patients once they are discharged from the hospital.

Is your organization ready for the ACO movement? Many experts in the healthcare field speculate that the ACO movement will be the most comprehensive and intense change to hit the SNF since the implementation of OBRA. It is imperative for SNF to build relationships with their local hospitals. The successful provider must be prepared to understand and endorse the ACO’s requirements if they want a bargaining chair at the table. The ACO movement requires a major culture shift in the day-to-day operations of the SNF, HHA and the ALF.

In many instances, Amplio HCI’s trained professionals understand the hospital acute side of healthcare as well as the short and long-term rehab facilities, and they can lead your organization to meet the challenges and opportunities of the ACO movement.

Let Amplio HCI assist your organization to identify interventions to ensure a smooth transition from the Hospital to the SNF.

• Skilled Nursing Facility: The foundations for accountability
  • Amplio HCI consultants provide the tools to develop an accountable workplace environment. Simply put, they identify the problem; determine the desire outcome; develop and implement the steps; and enjoy the success. Accountability must be woven into the fabric of the day-to-day operations.  Hospitals will evaluate the SNF to determine if they fit their accountability requirements. Overall performance is usually determined by several factors: adherence to state and federal requirements (performance measurement); community reputation (performance perception); and history with the hospital (admissions and transfers).
    • The SNF must analyze their historical performance data to determine their relationship with the hospital and to identify their transfer or return to the hospital rate. Hospitals may encourage their physicians and family members to transfer their patients to facilities with strong quality-performance indicators and lower hospital-readmission rates.  SNFs must capitalize on positive information by incorporating it into the marketing literature. All problem areas’ data must be addressed and improved.   SNFs often gather reams of data but fail to utilize the information to improve performance — an obstacle to accountability. Every interaction with the hospital has value.
      • Amplio consultants analyze historical data to identify positive and negative performance in the rate of transfer back to the hospital. They use this information to develop their accountable care statement.
    • Accurate resident assessment:  It is imperative for the SNF to avoid unnecessary resident transfers to the hospital.  The basic foundation of healthcare accountability starts with care management by the interdisciplinary team. The licensed staff must identify changes in condition at the onset and implement a treatment plan before problems become full blown. Systems must be in place to ensure accurate assessment and discharge, starting with the referral.
      • Amplio consultants use a root cause analysis to identify the strengths and weaknesses of the nursing department. They develop working tools for comprehensive assessment. They use this information to improve accountability.
    • Customer service must start when the phone rings and at the entry door.  Staff accountability and personal responsibility must be woven in the fabric of the organization.   The healthcare consumer today is well informed and demands to be part of the decision-making process when it comes to their healthcare.  Communication is the foundation for building positive relationships.
      • Amplio consultants work side-by-side with key staff members to identify steps to improve the interactions between staff and residents. They use this information to maintain accountability.

Under the proposed rule, all providers of services to patients will continue to receive Medicare reimbursement payments as they currently do, such as DRGs for hospitals, RUGs for nursing homes and the RBRVS for physicians.  The ACO payment system has no direct impact on the reimbursement structure to nursing homes, but could have a devastating impact or the overall bottom line of nursing homes if Medicare discharges are steered away from their organization based on poor quality outcome measures or readmission performance.  AmplioHCI can be your secret weapon to leverage your facilities strengths and effectively mitigate your facilities liabilities and risks.

Hospitals must partner with Accountable Care Organizations

Let Amplio HCI assist your organization to identify interventions to ensure a smooth transition from the Hospital to the SNF.

• Under the proposed rule, all providers of services to patients will continue to receive Medicare reimbursement payments as they currently do, such as DRGs for hospitals, RUGs for nursing homes and RBRVS for physicians.  The ACO payment system has no direct impact on the reimbursement structure to nursing homes but could have a devastating impact or the overall bottom line of nursing homes if Medicare discharges are steered away from their organization based on poor quality outcome measures or readmission performance.
  • The Hospital will need to affiliate or create an organized system to provide some level of control in managing the patient post-discharge.  The hospital’s success at becoming an Accountable Care Organization will go beyond its concrete walls and will depend largely on what happens to the patient following discharge. It is imperative for the hospitals to develop relationships with nursing homes and home health agencies to provide quality care.
    • Amplio consultants know the “hidden tips” for a successful discharge to the SNF.
    • Develop a plan or enhance the existing strategy for handling post-acute-care patients. Determine what levels of care the SNF wants to offer, and develop a team of professionals with the responsibility of managing the business. This should include all facets such as centralizing costs, measuring results, marketing services and maintaining relationships.  Identify “best practice” interventions to decrease exacerbation of chronic diseases;  Chronic Obstructive Lung Disease (COPD) and Congestive Heart Failure (CHF).

• Amplio consultants know both the acute and long-term care settings and can lead both the hospital and the SNF to develop systems to ensure a successful discharge.

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