In partnership with editorial staff at Provider magazine, providers from both large and individually owned long term/post-acute care centers came together for an Executive Roundtable titled, “Emerging Reimbursement Models: Preparing for What Lies Ahead for Skilled Nursing.” Sponsored by American HealthTech, the event was held during the 2015 American Health Care Association (AHCA)/National Center for Assisted Living Annual Convention & Expo.

 

Medicare, which turned 50 this year, is undergoing a makeover. In January, Health and Human Services (HHS) Secretary Sylvia Burwell announced measureable goals and a timeline to move the program, and the health care system at large, toward paying providers based on the quality rather than the quantity of care they give patients.

 

HHS has set a goal to tie 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and 50 percent of payments to these models by the end of 2018. Additionally, HHS set a goal to tie 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value-Based Purchasing and the Hospital Readmissions Reductions programs.

 

“It’s something we need to discuss,” said Bill Levering, roundtable participant and president and chief executive officer of Levering Management, a family-owned company comprised of skilled nursing facilities, assisted living, senior living apartment communities, and home care. “Long term care has to be part of the handling of the payment…We simply can’t be last in line for payments and expect the outcomes to be the same as today.”

 

Four alternative payment models have emerged to accomplish HHS’ goals. The first is fee-for-service that is not linked to quality or efficiency but rather quantity or the volume of services. This model is falling by the wayside as most Medicare payments are now linked to the second model, fee-for-service based on quality, which includes hospital value-based purchasing, physician value-based modifier, and the readmissions/hospital-acquired condition reduction programs.

 

The third and fourth models, which the majority of the panelists said they participated in, include ACOs and bundled payments. AHCA Senior Director of Medicare Research and Reimbursement James Michel said that the association is tracking these payment programs. He added that the messaging around the topics is changing, from fear of the unknown to acceptance and understanding, and recently, how to

innovate.

 

“Our goal is not only to prepare the overall industry … but to position our members ahead of our industry as well,” said Michel. “We are tracking provider members engaged in models two and three. When we look at the overall provider participants, skilled nursing facilities make up over half of these models. We’ve shown CMS [Centers for Medicare & Medicaid Services] that we are stepping up.”

 

One way providers are facing the challenges is through data sharing and innovation.

 

“That’s where it starts, being on the forefront and knowing what those changes are. I can make those changes before they want it,” said David Norsworthy, vice president of strategic planning with Central Arkansas Nursing Centers. “If I’m not up front and not there, then I will get run over.”

 

Software companies have emerged on the scene to help providers manage their health and outcomes records.

 

“We’ve been talking interoperability for years,” said American HealthTech President Teresa Chase, who announced that a new data system related to Medicare payments will be launched in January. “It all rests on collaboration and coordination. If not, you will find yourself nickeled and dimed to death.”

 

Concern was raised for the independent, single facilities and providers to rural communities.

 

“It’s a whole different ball game for a single facility… [that] doesn’t have the software,” said Harry Baum, MD, president of C&H Healthcare. “I don’t want these people to be left out of the mix. They need to have a voice in this..If we lose [them] we’d lose a large part of what long term care is really all about.”

 

Steven Hatlestad, senior vice president of Americare, a rural-based company in Missouri, shared with the panel how he is using AHCA’s TrendTracker data “to prove we’re not just rural American but sophisticated acute/post-acute services. I’m not telling them to call me, I’m calling them.”

 

Chief Operating Officer of Medicalodges Fred Benjamin, who co-moderated the discussion with Provider Editor in Chief Joanne Erickson, said that AHCA is working on its own Medicare reimbursement payment models. “If everyone drinks at the same trough, we’re all going to be thirsty,” he said.

 

At the summaries portion of the session, Senior Vice President of National HealthCare Corp. Gerald Coggin said that the emphasis should not only be on the financial bottom line.

 

“Sadly, there’ll be winners and losers. We do have to accept [that] episodic payments are coming,” he said. “As long as we focus on continuing to care for our patients, we’ll be OK.”