Healthcare Headlines: November 2019

<h2 class="heading-medium">Medicare Shared Savings ACOs Generated $1.7b In Savings In 2018
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<p>CMS announced that the 2018 Medicare Shared Savings Program generated $1.7 billion in total savings. It also reported that ACOs in the shared savings and risk-based models saw reductions in per-enrollee spending. ACOs that took on downside risk generated more savings than ACOs that did not. See the full report for more on how ACOs are trending.&nbsp;<a href="https://www.healthleadersmedia.com/finance/medicare-shared-savings-acos-generated-17b-savings-2018" target="_blank" aria-label="Read more about Medicare Shared Savings ACOs Generated $1.7b In Savings In 2018">Read more</a></p>
<h2 class="heading-medium">Number Of Certified Physician Assistants Surging
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<p>The U.S. Bureau of Labor Statistics projects 31% growth in the PA profession from 2018 to 2028, which the federal agency characterizes as "much faster than average" compared to other occupations. With the anticipated physician shortage, many think that physician assistant participation in clinical care teams is the solution. Check out the full analysis for more on the shifting role of PAs.&nbsp;<a href="https://www.healthleadersmedia.com/welcome-ad?toURL=/clinical-care/number-certified-physician-assistants-surging" target="_blank" aria-label="Read more about Number Of Certified Physician Assistants Surging">Read more</a></p>
<h2 class="heading-medium">CDC Updates Guidelines To Prevent Infections In Health Care Personnel
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<p>The Centers for Disease Control and Prevention released an <a href="https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/exec-summary.html" target="_blank">update</a>&nbsp;to its 1998 guidelines to prevent and control infection in the health care workplace. While the guidelines are intended for health care leaders and staff who address workplace health and safety, the guidelines themselves apply to a broader range of health care settings than before. Read the full guidelines for more on ways to prevent infections in your setting.&nbsp;<a href="https://www.aha.org/news/headline/2019-10-21-cdc-updates-guidelines-prevent-infections-health-care-personnel" target="_blank" aria-label="Read more about CDC Updates Guidelines To Prevent Infections In Health Care Personnel">Read more</a></p>
<h2 class="heading-medium">More ACOs Taking On Downside Risk, Analysis Finds
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<p>Research shows that ACOs participating in the Medicare Shared Savings Program are increasingly moving toward downside financial risk through value-based contracts. The percentage participating in downside risk programs has grown from 2% the first performance year of the MSSP (2012) to approximately 30%. Check out the full article for more on these trends and the implications of downside risk.&nbsp;<a href="https://www.healthaffairs.org/do/10.1377/hblog20191020.962600/full/" target="_blank" aria-label="Read more about More ACOs Taking On Downside Risk, Analysis Finds">Read more</a></p>
<h2 class="heading-medium">60% Of Younger Patients Will Switch Healthcare Providers Over A Poor Digital Experience: Survey
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<p>Half of consumers say they are frustrated about their provider&rsquo;s lack of adoption of digital administrative processes, such as online bill pay, access to insurance information and digital pre-appointment forms, according to a recent survey. What&rsquo;s more striking is that many patients are willing to ditch their healthcare providers for their slow adoption of modern technology &ndash; 41% said they would stop going while 1 in 5 said they had already stopped or switched providers over a poor digital experience. Read the full article to avoid these pitfalls.&nbsp;<a href="https://www.fiercehealthcare.com/tech/60-younger-patients-will-switch-healthcare-providers-over-a-poor-digital-experience-survey" target="_blank" aria-label="Read more about 60% Of Younger Patients Will Switch Healthcare Providers Over A Poor Digital Experience: Survey">Read more</a></p>
<h2 class="heading-medium">Rapid Expansion Of Telehealth Comes With New Challenges
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<p>The growth of telehealth is being met with regulatory risk that is largely due to the interplay between state regulations and federal policies, and the fact that state regulations widely vary from one to the next. See the full text to learn more about how these challenges, especially those related to reimbursement, are inhibiting the full potential of these new delivery methods.&nbsp;<a href="https://www.statnews.com/2019/10/21/telehealth-rapid-expansion-offers-challenges/" target="_blank" aria-label="Read more about Rapid Expansion Of Telehealth Comes With New Challenges">Read more</a></p>
<h2 class="heading-medium">Knock Pressure Injury Rates Down To Zero: 5 Ways
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<p>In 2018, the Dermal Defense Team at Temple University Hospital set out to achieve zero Stage 3 and Stage 4 pressure injuries developed by patients after a hospital admission. Through education, risk assessment, and other prevention protocols, the goal was met. Learn the 5 strategies they used to achieve success in preventing pressure injuries.&nbsp;<a href="https://www.psqh.com/news/knock-pressure-injury-rates-down-to-zero/" target="_blank" aria-label="Read more about Knock Pressure Injury Rates Down To Zero: 5 Ways">Read more</a></p>

The Importance of Post-Acute Care Within ACOs

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<a class="btn btn-blue _gt" data-category="Hospital" data-action="Click-Button" data-label="Blog The Importance of Post-Acute Care Within ACOs" href="https://www.kindredhealthcare.com/docs/default-source/default-document-library/kindred-hd-acos.pdf?sfvrsn=95b58cea_2" title="The Importance of Post-Acute Care Within ACOs" target="_blank">Download this article as a PDF</a>
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<p>Accountable Care Organizations (ACOs) have been around for nearly a decade, but ongoing changes to the model can be hard to keep up with. As a result, there is often a misconception that only short-term acute care hospitals are included in ACOs. In reality, long-term acute care hospitals play a vital role as well.</p>
<p><strong>In this white paper, learn the latest changes and trends in ACOs as well as strategies needed in post-acute care to succeed in the changing value-based landscape.</strong></p>
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<h2><strong>What Is an ACO?</strong></h2>
<p>ACOs are legal entities voluntarily assembled by providers for the purpose of improving patient outcomes and reducing costs. They do this by providing a seamless continuum of care focused on preventive health and quality outcomes. ACOs also provide support for participating physicians with interoperability, Electronic Healthcare Records (EHR), the Merit-based Incentive Payment System (MIPS) bonus eligibility and reporting technology.</p>
<p>In addition to this eligibility for MIPS value-based payment adjustments, ACO providers are rewarded financially by sharing in the cost savings achieved. CMS has provided waiver protection for ACOs to enable savings to be shared, and for post-acute provider network utilization management with the objective of improving care. These waivers allow providers to coordinate care improvement, while remaining compliant with Stark Law.</p>
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<h2><strong>Evolving ACOs and Benefits to Providers</strong></h2>
<p>The ACO model has evolved since regulation debut in 2009, and it looks as though ACOs are here to stay. Patients covered by Medicare ACOs rose from 10.5 million in 2018 to 10.9 million in 2019, according to CMS<sup>1</sup>.</p>
<p>Growth is good, but what about the changes that mandate migrating more of the risk to ACO members? Previously, ACOs were only rewarded for quality and cost savings, and were not held responsible for missing such targets. But a January 2020 redesign of the federal Shared Savings Program requires ACOs to take on more risk in the form of paying CMS back when they miss their cost-savings targets. In exchange for sharing in the risk, ACOs will be rewarded with &ldquo;higher levels of shared savings and greater regulatory flexibility,&rdquo; according to Health Affairs.</p>
<p>ACOs are permitted to shift to the new program over a number of years, but nearly half of new ACOs starting on July 1, 2019, had opted for the downside risk program. And early data suggests the model isn&rsquo;t as risky as it sounds. ACOs that have taken accountability for missing cost-savings targets perform better than ACOs still in shared savings-only programs<sup>2</sup>.</p>
<p>With the coming ACO changes, providers should consider their network partners carefully.</p>
<h2><strong>Three Keys to a Successful ACO</strong></h2>
<p>Successful ACOs benefit providers, patients and tax payers. There are three keys to making an ACO successful:</p>
<p><img class="float-right" src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-acos-whitepaper-infographic-1.jpg?sfvrsn=f6c28cea_0" data-displaymode="Original" alt="Three Keys to a Successful ACO" title="Three Keys to a Successful ACO" /></p>
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<li><strong>Prevention.</strong> With metrics based on quality and patient outcomes, working with patients to help them stay well is the crux of everything ACOs do. This, of course, is reliant on maintaining good connections with patients as well as being proactive and consistent with PCP and specialist visits. These efforts and good post-acute partners help ensure that when an acute episode of care occurs, the ACO patient is steered back into preventive pathways by the post-acute setting.<br />
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<li><strong>At-risk patient identification. </strong>High-risk patients are the most costly to treat. About 20% of all healthcare expenditures come from the top 1% of the nation&rsquo;s neediest patients, according to the National Academy of Medicine<sup>3</sup>. So in order to control costs, ACOs need to be able to identify their highest-risk patients. They then must assist them with preventive care and offer chronic-disease management to keep them from requiring more costly acute care.<br />
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<li><strong>Care transitions.</strong> Every time patients transition from one care setting to another there is the potential that they&rsquo;ll disengage from the healthcare system or there is a gap in care, putting them at risk for further health problems and rehospitalizations. ACOs must shepherd patients through such transitions to keep patients actively participating in the preventive care loop and maintaining wellness.</li>
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<p>It is important for all members of an ACO to be aware of &mdash; and to execute &mdash; these success factors for optimal patient and provider benefit, including the acute and post-acute setting participants.</p>
<h2><strong>The Role of Post-Acute Care in an ACO</strong></h2>
<p><img class="float-right" src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-acos-whitepaper-infographic-2.jpg?sfvrsn=e4c28cea_0" data-displaymode="Original" alt="Only 0.03% to 3.3% of all discharging hospital patients require care in an LTAC hospital" title="Only 0.03% to 3.3% of all discharging hospital patients require care in an LTAC hospital" /></p>
<p>Building a clinically robust continuum of care includes long-term acute care (LTAC) hospitals. While only a small percentage of patients &mdash; between 0.3% and 3.3% &mdash; require transitional care in an LTAC hospital<sup>4</sup>, they are some of the sickest patients. Meaning they are the highest risk for readmission, suffer from multiple chronic conditions and have the greatest need to connect with PCPs and specialists on an ongoing basis. Further, caring for this population through placement in the most clinically appropriate settings also has the greatest opportunity to affect outcomes and cost of care.</p>
<p>Releasing chronically, critically ill patients from acute care settings directly to a skilled nursing facility (where care is nurse-led rather than physician-led) can pose substantial risk to patients&rsquo; health and is therefore misaligned with the goal of an ACO. And yet, keeping patients in acute care settings long-term is costly. LTAC hospitals provide intensive care while actively preparing patients to transition home, improving outcomes and reducing costly readmissions.</p>
<p>CMS data consistently shows that patients identified as being the &ldquo;sickest&rdquo;&mdash; meaning they spent three or more midnights in an ICU and require ventilator management &mdash; and transition to LTAC hospitals receive care that is &ldquo;as good or better&rdquo; and &ldquo;costs the same or less&rdquo; as compared with patients who bypass the LTAC hospital setting and use only short-term acute care hospitals and skilled nursing facilities. And, according to 2012 data, which is the most recent available, matched patients treated in LTAC hospitals were readmitted 44% less often than similar patients who were treated in other post-acute settings<sup>5</sup>.</p>
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<h2><strong>Choosing a LTAC Hospital Partner for an ACO</strong></h2>
<p>Acute care providers and ACOs need partners that can continue to provide physician-directed care with the extended recovery time that chronically, critically ill patients need. Kindred Hospitals specialize in the post-intensive care treatment of patients with complex medical cases requiring continued intensive care and specialized rehabilitation in an acute hospital setting. With daily physician oversight, ICU- and CCU-level staffing and specially trained caregivers, we work to improve outcomes, reduce costly readmissions and help patients transition home or to a lower level of care.</p>
<p>We are committed to pursuing innovations in care delivery and payment models to provide new tools and solutions to our patients and their families as well as our provider partners. Many of these resources and initiatives are designed to ensure efficient care management for each patient, for whom we have the honor to provide care and play perfectly into the three key factors of an ACO mentioned above.</p>
<p>One such service is our AfterCare program. The&nbsp;<strong>AfterCare</strong> program ensures a smooth transition for patients who discharge directly home from Kindred. Our Registered Nurses contact patients by phone in the first 24-48 hours post discharge and then one week, two weeks and 30 days post-discharge to assess their progress and identify any post-discharge needs, such as explaining their medication and getting an appointment scheduled with their PCP within 7-14 days. The AfterCare program has proven successful in decreasing rehospitalization rates and removing gaps/barriers in care at the patient&rsquo;s home, offering immense benefit to upstream partners in the aim of prevention.</p>
<p> Additionally, with a focus on at-risk patient identification, our hospitals all across the country have achieved or are seeking disease-specific certification from The Joint Commission for sepsis and respiratory failure. While we have proven success in treating these patients, the changing patient landscape of older patients with more chronic conditions encourages the continued clinical growth and expertise this population will demand.</p>
<p><strong>Case Study: Kindred&rsquo;s Long-Time ACO Experience</strong></p>
<p>Kindred is the LTAC hospital partner of choice for many health systems and ACOs across the country. We are well-versed in the drivers of value-based care and are proven participants in generating ACO savings. We believe that being collaborative and transparent with our partner ACOs and payers is behind that success. </p>
<p>In 2014, Kindred became the majority owner of Silver State Accountable Care Organization. This strategic partnership created the largest ACO in the market and in the top 20% nationally, with more than 400 physician partners serving approximately 42,000 patients<sup>6</sup>.</p>
<p>Kindred has been not only Silver State ACO&rsquo;s LTAC hospital of choice, but we&rsquo;ve also handled all network and care management for the ACO for the past 5 years, helping Silver State ACO consistently generate savings to share with CMS:</p>
<ul>
<li>$6.3 million in 2015</li>
<li>$15 million in 2016</li>
<li>$15 million in 2017</li>
</ul>
<p><strong><strong><strong>To learn more about how Kindred can help your ACO achieve similar shared savings</strong>,&nbsp;<a href="https://www.kindredhealthcare.com/our-services/transitional-care-hospitals/healthcare-professionals" target="_blank">Contact Us</a>.</strong></strong></p>
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<p>References:</p>
<span style="font-size: 12px;">2:&nbsp;<em>More ACOs Taking Accountability Under MSSP Through &lsquo;Pathways To Success&rsquo;</em></span>
<span style="font-size: 12px;">4:&nbsp;<em>2017 MEDPAR Final File<br />
</em>5:&nbsp;<em>Post-Acute Care Payment Reform Demonstration: Final Report</em></span>
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