Disruption for Post-Acute Medical Care in 2017
Moving beyond a decade that was consumed by CMS mandates, healthcare executives are now fixing their sights on what it will take to succeed in the healthcare marketplace of the future. Leaders are shifting their attention from unnecessary readmissions and hospital-acquired conditions to addressing staffing shortages, improving revenue cycle management, developing the infrastructure needed to support value-based healthcare, and anticipating likely changes from the new Trump administration. As we look forward into 2017, here are two of the many new trends you can expect to see.
The world of the physician will be further disrupted
According to Dr. Miles Snowden, Chief Medical Officer of Knoxville-based TeamHealth, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) represents the biggest change for physicians that he has witnessed in his 40-year career in healthcare. This is no small statement for someone who was a former CMO for United Healthcare and Delta Airlines before joining TeamHealth in 2014.
MACRA is a value-based reimbursement plan in which physicians will be at risk for +/- 9% of their compensation based on their performance on a wide range of quality metrics. According to a recent study by Deloitte, many providers are completely unaware of the MACRA program and are “in for a notable awakening when the law takes place in 2017” (Heath, 2016).
This industry-changing payment reform is impacting physicians who are already beaten-down by recent changes in the healthcare system. In recent years, they have had to absorb the complexities of ICD-10 coding, the transition to electronic health records, new billing models, cyber security issues, a rash of new government regulations, taking on the role of “financial counselor” with their patients, and an overwhelming loss of autonomy, just to name a few of the changes.
The result has been an epidemic of burnout among physicians. According to burnout expert, Dr. Dike Drummond, as many as one in three physicians suffer from burnout, a condition that is directly linked to an impressive list of negative consequences such as higher medical error rates, higher turnover, alcohol and drug addiction, and physician suicide (Drummond, 2014).
There will be radical change in the look of post-acute care
Post-acute care (PAC) is the skilled nursing care and therapy that often follows an inpatient hospital stay (Blum, 2013). It typically includes care provided in one of four settings: long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs). According to the American Hospital Association (AHA), PAC services are used by nearly 42% of Medicare beneficiaries who are discharged from a hospital (AHA, 2015).
Demand for these services is growing as our population ages, and with this increased focus comes a higher demand for more enriching experiences for seniors receiving this care. A number of new housing trends are redefining the traditional nursing home model. One industry expert makes a number of predictions about the future of assisted living (Stevenson, 2013):
- Look for richer experiences for memory-challenged residents. Redmond, Washington-based Aegis Living is building a senior community reminiscent of the 1950s. They are re-creating the look and feel of this time period to support seniors with dementia who deal best with long-term memories.
- Expect technology-enhanced senior care.
Up-and-coming technology is likely to revolutionize senior care as we know it. Be on the lookout for everything from smart carpets that can predict falls to personal care robots to smart home computer systems that keep track of medications.
- Anticipate multi-generational housing. More and more families are likely to pool their resources to modify existing homes to suit multiple generations or move into a place that is built to house both young families and older adults.
- Count on more seniors aging in place. For seniors who want to remain living independently in their own home for as long as possible, the home health care and personal care industries are stepping up to provide assistance. The Bureau of Labor Statistics predicts job growth of 70% for home health and personal care aides over the coming decade.
Another impetus for change in the post-acute world is increased scrutiny and regulation by CMS. Beginning in FY2018, skilled nursing facilities will suffer financial penalties if their hospital readmissions rates are higher than expected. In April 2016, CMS instituted a mandatory hip and knee replacement bundled payment program in selected markets in the U.S. The payment bundle includes the inpatient care for the joint replacement surgery and all additional care provided during the 90-day period following discharge. CMS has proposed to bundle 50% of all PAC payments by 2020.
In response, expect to see post-acute providers taking steps to become “valued partners” to hospitals in their markets. For example, we can anticipate customized accommodations, nursing care, and rehab programs for patients covered under bundled payment arrangements. We can also anticipate more SNF acquisitions of home health and hospice providers to improve patient transitions.
Contact HealthStream to speak to a solutions expert learn more about our courses related to progressive non acute medical care.
American Hospital Association (AHA), “The Role of Post-Acute Care in the New Care Models,” TrendWatch, http://www.aha.org/research/reports/tw/15dec-tw-postacute.pdf, December, 2015.
Drummond, Dike, MD. Stop Physician Burnout: What to Do When Working Harder Isn’t Working, Heritage Press Publications, LLC, 2014.
Heath, Sara. “Tracking MACRA’s Progress toward Industrywide Implementation,” EHRIntelligence, https://ehrintelligence.com/news/tracking-macras-progress-towardindustrywide-implementation, July 21, 2016.
Stevenson, Sarah. “8 Predictions about the Future of Assisted Living,” A Place for Mom, http://www.aplaceformom.com/blog/2013-8-27-future-senior-care/, August 27, 2013.