Preparing for value-based care: Questions for every SNF

Next year the Centers for Medicare and Medicaid Services will begin creating the Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP) that is scheduled to be launched in 2019. Based on what CMS has shared about the program so far, and considering what it has done with other value-driven programs, it is evident that the SNFVBP will make payments to participating nursing homes based on the quality of care (not quantity of services) they provide. That means the program will offer financial incentives for things like quality of care, resident experiences and for resident health outcomes.

In order to be ready for the payment changes that will accompany the SNFVBP, nursing homes need to begin preparing now. Below are some questions nursing homes should ask (and answer) to evaluate their readiness for value-based payments. “Yes” answers indicate readiness in a particular area. “No” responses suggest that there is still work to do to prepare for the transition from fee-for-service to value based care.

Are we involving residents and their families in care planning?  

It is more effective to align care plans with the needs of individuals when residents and their family members are engaged and involved in care planning. That is why nursing homes need work to include both residents and family members in planning meetings whenever possible. The nursing home team should listen to concerns, answer questions and encourage residents to be reasonably involved in making decisions about their care. This involvement will create more resident-centered care, as well as a better overall care experience.

Are we asking residents and families for feedback to measure their overall satisfaction?

Some value-based payment models use satisfaction as a quality measure that impacts reimbursement. Therefore, it is important to ask for feedback and try to understand how people feel about the services they are provided. Nursing homes can use questionnaires and surveys to gather feedback. Then, based on the responses, they can determine where changes are needed in order to improve resident and family satisfaction.

Do we have procedures in place that are designed to help residents adjust as they transfer in and out of our facility? Are they effective?

Care transitions can be particularly difficult for elderly residents. During and after transitions, residents are more likely to experience complications and require acute care. It is important to monitor patients closely and put precautions in place to help prevent transition-related issues. This can include doing things like revising transfer forms and working with hospitals to improve procedures for communicating information prior to transitions.

Are we using electronic health records?   

A lot of nursing homes have not adopted EHR technology because of the investment it takes to put an EHR system in place. But EHRs can be a game-changer for nursing homes. Updating from paper to electronic records makes data sharing easier. It also brings efficiency into facilities and it helps staff better track changes in the health of residents. Organizations that do not have an EHR system in place need to make it a priority to remove any barriers and gain access to this technology.

Are we using hospital transfer data to determine a baseline, set goals and measure our progress toward reducing hospital readmissions?  

CMS could not be more clear about the fact that it wants to reduce hospital readmissions, or that it expects hospitals and nursing homes to work together to accomplish this goal. In light of this, nursing homes need to be measuring and really keeping an eye on readmission rates for their organizations. That means looking at hospital transfer data and making comparisons each month, each quarter, etc., to determine whether you are making progress toward reducing readmissions.

Do we have good working relationships with the hospitals and home health providers in our community?

Forming strong working relationships with hospitals, home health providers, pharmacies, and others that serve shared patients not only makes it easier to offer more coordinated and safer care to residents, but it is necessary to be successful under value-based care models that reward care coordination. Nursing homes can form a community-based coalition to bring providers together and discuss how all parties can work together to improve care coordination.

Is there a trusted person or partner in charge of directing our quality improvement efforts?     

Nursing homes are still awaiting the official launch of CMS’ Quality Assurance and Performance Improvement (QAPI) era, but many are already preparing for the rollout of the program. QAPI programs must address all systems of care and management; focus on clinical, quality of life and resident choice areas; use evidence to define and measure indicators of quality and set goals; and reflect a facility’s unique resident make up and services. Nursing homes should assign one person (or a team) within their organization the job of managing quality improvement. It may also make sense to bring in a knowledgeable partner to assess an organization’s current quality improvement efforts, develop improvement strategies and help charter performance improvement project teams.

Questions like the ones above can help nursing homes understand what they need to do to prepare for shifting payments. However, answering these questions is the easy part. The next step is making organizational changes – and it is much more complicated. That is why nursing homes need to get to work now and utilize the time they have before the SNFVBP and other value-driven regulations are put into effect.