Beginning October 1, 2018 (FY2019), SNFs will begin to face monetary incentives and penalties associated with hospital readmissions of Medicare beneficiaries, as a consequence of CMS’ SNF Value-Based Purchasing (VBP) Program. The SNF 30-Day All-Cause Readmission Measure will track all patients readmitted to the hospital within 30 days of being admitted to a SNF within 24 hours of a hospital discharge. If a readmission to the hospital occurs within 30 days of the SNF admission date, the readmission will count against the facility’s achievement and benchmark threshold to determine the financial penalty/incentive amount received. The VBP program mandates that CMS must reduce all SNF Medicare payments by two percentage points, then distribute incentive payments to all SNFs based on their quality performance, but not more than 60% of the total reduction. The best performing facilities will have the opportunity to earn back almost all of the 2% withhold, while the poorest performing facilities may earn back nothing.
Functional impairment is associated with increased risk of 30-day, all-cause hospital readmission in Medicare seniors.a Functional impairment is an often overlooked but highly suitable target for interventions to reduce Medicare hospital readmissions. The implementation of ACP’s evidence-based clinical programs has been shown to yield greater functional improvement in self-care and mobility outcomes as compared to patients with traditional therapy.
To help objectively quantify the impact of comprehensive clinical programming augmented by physical agent modalities, ACP contracted with The Moran Company in 2016 to conduct an independent analysis of functional outcomes related to the delivery of physical and occupational therapy is skilled nursing facilities with a focus on specific biophysical agents – diathermy, electrical stimulation, and ultrasound - supported by ACP training and program support.
The Moran Company used data from over 25,000 Medicare A stays across 81 Skilled Nursing Facilities to assess the difference in functional outcomes between those patients that received treatment augmented by ACP program modalities and those that did not. The results of the analysis revealed that in the self-care domain, the use of one or more of the study modalities yielded an improved outcome of 38%. In contrast, treatment delivered without the use of modality yielded an improvement of 27%, demonstrating an 11 percentage point difference between treatment with physical agent modalities vs. treatment without.
In the mobility domain, the use of one or more of the study modalities yielded an improved outcome of 66% compared to a 43% improvement for treatment delivered without a modality, a 23 percentage point difference between treatment with PAMs vs. treatment without.
Interestingly, individuals treated with modalities began at an overall lower level of function in self-care and mobility when compared to those that did not receive modality intervention; yet the end scores for those individuals who received treatment with modalities exceeded those that did not. Additional analysis revealed the average improvement in overall self-care and mobility functional assessment scores were greater for those treated with modalities than for those that were not, across all levels of assistance.
The overall conclusion of the study is that the use of biophysical agents, when clinically indicated, can yield efficient, effective treatment outcomes across levels of independence that are superior to therapy services rendered without biophysical agents. Biophysical agents offer a non-pharmaceutical option to address common underlying impairments, such as pain, edema, tissue injury, and sarcopenia, all of which can negatively impact function. The use of biophysical agents as a compliment to a holistic rehabilitation treatment philosophy that is clinical outcome focused has been proven to optimize gains in function.
The greater rate of improvement achieved when modalities are incorporated as an adjunct to a strong clinical rehab program are certainly important from a patient quality of life perspective, but these results are also operationally impactful if we view them in relation to the new Value-Based Purchasing (VBP) Program SNF 30-Day All-Cause Readmission Measure. Achieving higher levels of functional independence at discharge from post-acute care is associated with a decreased risk of rehospitalization. ACP clinical programs and rehabilitative technologies can help your facility position itself to benefit from monetary incentives and minimize risk of penalties associated with high rates of hospital recidivism under the SNF VBP program.
Greysen S, Senzer I, Auerback A, Covinsky K. Functional Impairment and Hospital Readmission in Medicare Seniors. JAMA Intern Med. 2015 April 1; 175(4): 559-565.
The Moran Company, The Moran Company Report on Therapy Outcomes for Selected Modalities, December 2016