90% of SNFs Predict No Shift in Value-Based Payments in 2020

November 21, 2019 - Long-term and post-acute care providers cannot move forward with value-based payment implementation without the support of technology, according to a recent Black Book Research survey.

The survey of 1,640 providers of long-term and post-acute care providers found that nearly 90 percent of skilled nursing and sub-acute facilities predict no shift in the portion of their payments from value-based care models in 2020. The primary reason why: lack of health IT capabilities and preparation.

Almost one-half (49 percent) of all post-acute providers said the state of their staff’s health IT proficiency was extremely poor or non-existent.

“All healthcare organizations must find better ways to manage the patient transition into post-acute processes and keep hospital readmissions in check, and that may fall completely on hospital systems at risk in 2020,” Doug Brown, managing partner of Black Book Research, stated in the press release. “That answer will require the expansion of technology capabilities to connect physician practices, home health agencies, hospices, outpatient settings, skilled nursing facilities, rehabilitation centers, DME firms, and hospitals.”

Specifically, value-based payment implementation will require more robust use of EHR technology and data analytics software to support care coordination, the survey found.

READ MORE: Finding a Revenue Cycle Management System for Post-Acute Care

Only 21 percent of inpatient post-acute care providers reported having some technological capabilities of EHRs operational by the end of 2019. This percentage is up from 15 percent in 2016, but still significantly lower compared to other provider types.

Corporate chains and large non-profit systems had the highest EHR adoption rates among network post-acute care facilities at nearly 40 percent by the end of 2019. That percentage is up from 27 percent in 2016, the survey stated.

Data analytics software implementation also remained low among long-term and post-acute care providers surveyed. Only four percent of inpatient long-term care providers said their organization leveraged data-driven analytics to reduce costs, avoid unnecessary hospital readmissions, and ensure facilities earned accurate, complete reimbursement.

Health IT budgets may be holding long-term and post-acute care providers from shifting more of their revenues to value-based payment models, the survey indicated. Eighty-four percent of post-acute care administrators surveyed reported having no budgeted funds for technology acquisitions or improvements in 2019.

Furthermore, nearly three-quarters (72 percent) of post-acute care organizations did not have the internal human resources or capital to implement a health IT strategy and successfully adopt solutions in 2019, the survey revealed.

READ MORE: Importance of Post-Acute Alignment, Integration to Value-Based Care

But health IT implementation may not be the golden ticket for value-based long-term and post-acute care. Brown also pointed out that a cultural shift is needed to truly shift to value-based payments in this space.

“Most long-term care organizations are still stuck in a volume-based mindset,” he stated. “Integrating evidence-based practices through clinical operations can control rising costs, reduce duplication and other inefficiencies, and position the business to be a successful player in the reforming post-acute continuum.”

Connecting the long-term and post-acute care space to other providers could also help, the survey suggested.

Interoperability and communication are two major challenges in this space. Long-term care administrators said 86 percent of their facilities were not exchanging health information electronically with referring hospitals, physicians, and home health providers by the time of the survey, which represented no improvements compared to the 2017 survey of this group.

Additionally, 91 percent of care managers surveyed reported that hospitals send their most complex patients with the highest morbidity to skilled nursing facilities with little to no communication.

READ MORE: How Palomar Health Created a High-Value Post-Acute Care Network

“Long-term care facilities are still excluded from operating in a deeply connected care continuum due to limited resources and communication channels,” stated Brown.

These providers cannot afford to remain detached from the care continuum for much longer. The survey showed that 80 percent of long-term care organizations are already struggling to account for care, earn proper reimbursement, manage eligibility, prove medical necessity, and negotiate favorable reimbursement rates.

This problem could get worse as Medicare looks to shift post-acute care providers to a value-based payment system.

HHS Secretary Alex Azar vowed to shift skilled nursing facilities and other post-acute care providers to a value-based system in a 2018 speech at an American Health Care Association and National Center for Assisted Living conference.

“As our country ages, the systems we have for caring for older Americans must change,” he said. “One reason is that the finances simply will not work. We need higher quality, lower-cost settings for caring for older Americans with serious health conditions.”

HHS followed through on its promise, implementing the Patient Driven Payment Model for skilled nursing facilities in October 2019. The new payment system ties skilled nursing facility reimbursement to patient needs, rather than therapy volume.