Avalere Health
An Inovalon Company
Insights

Jun 20, 2014

An Opportunity for SNFs Through New Payment Models

Published

Jun 20, 2014

In this week’s edition of McKnight’s Long-Term Care, Jeff Terkowitz wrote a guest column discussing new payment models, and the opportunities they present for SNFs.

In particular, Jeff highlights the problems with the SNF three-day rule, a rule mandating Medicare beneficiaries to spend at least three nights in a hospital inpatient setting before becoming eligible for Medicare-covered SNF stays, thus making it difficult for SNFs to get patients in the right setting at the right time. Because many hospital stays for SNF-treatable conditions continue to decline, SNFs are placed in an unfortunate position.

Jeff further discusses new CMS demonstrations that explore payment for an episode of care that spans settings, as opposed to the current siloed payment structure.  It is these demonstrations that create new opportunities for SNFs.  For one, because the three-day rule can be waived, but also because they would enable SNFs to highlight their value as a successful PAC partner with the ability to drive down costs by treating patients who need SNF care the most. Congress and MedPAC also continue to discuss ways to eliminate the three-day rule altogether; however, CMS is more likely to lessen its burden, as opposed to a complete removal.

Jeff also highlights great ways for SNFs to succeed amid new payment models, especially those SNFs treating ACO or BPCI patients, which include:

Jeff also highlights great ways for SNFs to succeed amid new payment models, especially those SNFs treating ACO or BPCI patients, which include:

  • Know your market – Figure out if you have any BPCI model 2 participants or Pioneer ACOs.

    Know your market – Figure out if you have any BPCI model 2 participants or Pioneer ACOs.

  • Assess your capabilities - The best argument for waiving the three-day rule in negotiations with ACOs and BPCI participants is similar to the one you have with managed care companies who are looking to send patients to SNFs following shorter hospital stays.

    Assess your capabilities - The best argument for waiving the three-day rule in negotiations with ACOs and BPCI participants is similar to the one you have with managed care companies who are looking to send patients to SNFs following shorter hospital stays.

  • Target your outreach - Focus on specific patient characteristics to improve the receptiveness of your pitch with demonstration participants. View more information on opportunities for SNFs in the current marketplace, and read Jeff’s full post.

Back to Results
« Back to Mobile Site