Some hospitals say they are going to “narrow their network” for post-acute services based on quality. What can we do to continue to receive referrals?
The concept of narrowing the network of skilled nursing facilities (SNFs) to which a hospital will refer has gained momentum in some market areas. More often, it involves Medicare discharges for SNF care, related in large part to the increasing penalties in the Hospital Readmission Reduction Program (HRRP).
However, payers such as Medicare Advantage programs or even Medicaid managed care may use the concept of a network based on both quality and discounted costs. So let’s face it, as we move to more integrated models of care, whether for payment such as bundling, or value-based purchasing to reduce readmissions, “networks” of different types will be tried in different markets.
First, remember that, ideally, most hospitals and payers would like as large a post-acute network as possible of good quality providers. Provider location will remain critical in choosing both post-acute and long term care, both for the patient visitation by family and proximity to other health care services.
Thus, if hospitals can have a larger network of providers with whom they have successful partnerships, they would prefer that.
Except in the case of specific contracted plans, beneficiaries and families have a choice of providers, and often have multiple sources of input. As they become more sophisticated in choosing post-acute and long term care residences, they will be more discerning.
The profession is only in the early stages of developing models to track and compare quality metrics in post-acute settings, such as readmission rates for specific diagnoses.
Even though readmissions are the focus of some of the networks and models of care, this single metric is just one aspect of what you do.
His advice is to focus on measuring quality comprehensively and objectively.
I’ve studied readmission data from SNFs and potentially avoidable causes for many years, and their underlying importance is that lower rates of preventable hospital or Emergency Department visits means you are managing risks of infection, and unstable medical and surgical conditions, effectively.
So my advice is that you focus on measuring quality comprehensively and objectively, striving to continuously improve it, and report to health care partners about your quality and the systems you have in place to assure and improve it.
Also, recognize that the client is the resident and their family and that other providers, be they hospitals or physicians, often have difficulty evaluating the options based on different patients’ needs. You have to help them with information, but not by over-emphasizing a small set of metrics.
The Five-Star rating system on Nursing Home Compare, with all its limitations, has advantages over focusing exclusively on readmission rates and is the one external review of quality that all organizations receive.
So, as we have known for a long time, a commitment to continuously improving quality and complying with the evolving regulations remain critical. Furthermore, as residents and families have more choices in where they will receive care, customer experience is increasingly critical to monitor and improve on an ongoing basis.