Summary Parts 1-3
The Affordable Care Act (ACA), now found constitutional by the Supreme Court, continues to have significant impact on the nation’s health system presently and will have tremendous impact in the future.
In June and July Select Data ezine articles parts 1-3, we have discussed the ACA impact on
- New Health Care Delivery Models such as Accountable Care Organizations (ACO) and Patient Centered Medical Models (PCMM) www.CMS.HHS.gov/PCMM
- Bundled payments for hospital stays, physicians, and post-acute providers
- Value-based Purchasing
- Shared savings Programs (SSP)
- Electronic Health records
The ACA has even expanded the RAC requiring, in 2012, the audits of Medicare Part C and Part D as well as Medicaid. See www.cms.gov/medicaid/racs
It seems as if the reach of the ACA is everywhere in healthcare.
In this article, we will briefly discuss the ACA and its impact on hospital admissions and the Continuity of Care.
ACOs and significant payment reform encourage home health agencies partnering with physicians and hospitals to improve care transitions of patients through acute and post acute levels of care as well as reducing inpatient readmissions. Home health agencies may choose to investigate Guided Care and the evidenced-based guidelines for managing chronic conditions. Agencies need to develop innovative programs and should consider those based on the effective principles of case management, disease management, self management, and caregiver support models. Investigate the Guided Care Model, so your agency is prepared to interact with physician groups that adopt this model.
In the Patient Protection and Affordable Care Act (PPACA) commonly referred to as the ACA, Congress designed numerous provisions including the Hospital Readmissions Reduction Program (HRRP) which requires payments to applicable hospitals to be adjusted downward if the hospitals have excess readmissions.
CMS views operationally, three stages related to readmissions:
- Inpatient care processes
- Effective Discharge (soon to be termed transitional level planning)
- Post Discharge or transitional care
CMS and the OIG are reviewing transfer processes, rates of adverse events, and preventable hospital readmissions. Presently, the OIG are focusing on SNFs, IRFs, and Long Term Hospitals. Throughout this year and next year, the OIG will be focusing on these sites ostensibly seeking innovative ways to deliver care that aids in preventing readmissions. Here is where the innovative home health agency can shine. Start looking at stages two and three and how your agency can impact those processes.
In addition, beginning in FY2013, hospitals with specific risk-adjusted readmission rates for 30 days post discharge will receive reduced Medicare payments (up to 1%). By 2015, it can increase to 3%. Hospitals will be motivated to work with the creative home health agency.
Root cause analysis should be utilized to discover why each and every hospital readmission occurred. Agencies should analyze why home health care plans were ineffective in that area. Take them apart. Dissect by section. Look for weak areas so future plans might be strengthened. This is a new era for quality improvement team evaluation. Sharing data and establishing reasons for the readmission will assist both levels of care seek improved interventions.
Preventing hospital readmissions with innovative programs will position agencies to negotiate positive agreements with hospitals for ongoing referrals. Hospitals will be motivated to work with agencies with proven positive care methods that reduce acute care readmissions. The same old same old manner of delivering care may be seen as lacking.
It will be the home health agencies that focus on excellent care interventions in specialized programs that will be able to negotiate with acute care providers for future referrals. Care transitions means transitioning care from level to level. It means providing excellent care that meets an individual’s care needs in the least restrictive environment.