More on Reimbursement

HHS Secretary Alex Azar promotes value-based payment for skilled nursing facilities

The model ties payment to a patient's conditions and care needs rather than volume of services provided.

Susan Morse, Managing Editor

The government's new proposed value-based payment system for skilled nursing facilities, the patient driven payment model, represents a significant shift in how SNFs will be paid, Health and Human Services Secretary Alex Azar said Tuesday at the 2018 American Health Care Association and the National Center for Assisted Living Congressional Briefing.

The model ties skilled nursing facility payment to a patient's conditions and care needs rather than volume of services provided. Focusing on the needs of the whole patient instead of volume  reduces paperwork, lowering costs by $2 billion over the next decade, according to Azar.

Under the new skilled nursing facility prospective payment system  case-mix model, patients will have more opportunity to choose a skilled nursing facility that offers services tailored to their condition and preferences, as the payment to nursing homes will be based more on the patient's condition rather than the specific services provided by each skilled nursing facility.

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The prospective payment system starts with the FY 2019 payment. Comments are being accepted through June 26.

"We know quality reporting can be a complex task, and we have strived to make SNF quality assessments as simple as possible while still gathering the necessary, meaningful data," Azar said. "We are well aware of the huge burden that regulation places on so many healthcare professionals. Just so far in 2018, the CMS Patients Over Paperwork Initiative has pared back regulations to save providers more than 4 million hours of paperwork--4 million more hours that can be devoted to better patient care." 

Azar separated the silver tsunami into two groups of the leading and the trailing edges. The former will age as their parents did, likely moving somewhere for retirement and making major changes, but the trailing edge are more likely to want to age in place with expectations of a more consumer driven healthcare experience.

The trailing edge also has higher rates of diabetes than older boomers and a greater need of healthcare services for chronic conditions.

In 2016, there were 69 million Americans over age 60. By 2020, that number will be 77 million--and by 2040, it will be 102 million, Azar said.

"We know there can be disagreements among hospitals, payers and post-acute care providers about when it's appropriate for a patient to leave the post-acute care facility. We understand getting patients the right rehabilitation services helps keep them out of the highest cost settings: hospitals or inpatient rehab facilities," Azar said.

Twitter: @SusanJMorse
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