“The Times….They Are a-Changin”

There was a time when hospitals and skilled nursing facilities (SNF’s) would welcome you to their facilities with open arms, and gladly keep you there for as long as: 1) they thought they could help you, 2) your insurance (Medicare or Private) would pay for your stay. Keeping “the heads in the beds” was considered “good business”. Then along came the Affordable Care Act, with the intent being to: 1) Reduce Costs, 2) Improve Quality of Care, 3) Increase Access to Care for all Americans. Love it or hate it, the 2010 law is continuing to affect the way hospitals and SNF’s behave. While the understanding of the changes and the adoption of new policies has been slow, it is happening and we all must understand how it impacts our lives.

Many know that today, hospitals are being increasingly penalized for “re-admissions”, defined as a patient getting re-admitted within 30 days of discharge for the same condition. Hospitals are also getting very heavily scrutinized on what is called Medicare Spend per Beneficiary (MSPB), a comparative measure that evaluates how much a patient “costs” starting 3 days before, and ending 30 days after their discharge! To address some of these new challenges, many new payment model reforms have been introduced, such as “Bundled Payment for Care Initiative” (BPCI), using HMO-like tactics to manage care and costs.

Bottom line, EVERYONE will be impacted. How? Patients will be moved quickly to the setting offering the LOWEST COST OF CARE, this is almost always to the HOME environment. To do this successfully, a hospital and SNF must work in concert to ensure successful discharges, earlier than they historically have, but with a much more effective COORDINATION OF CARE. This approach to TRANSITIONAL CARE places a premium on finding the best Home Health (medical), Home Care (personal care) and/or the best Assisted Living or Memory Care Community. If done correctly, the costs are kept down while the quality of care is increased, keeping the individual out of the hospital and SNF…EVERYONE WINS! Even more importantly, patients MUST ACCEPT the help, to transition home or into a supportive community swiftly and smoothly. The statistics speak for themselves…. those that accept help at home, or to move into an appropriate Assisted Living or Memory Care community, are much less likely to head back to the hospital or SNF! Isn’t that what we ALL want after all?

Submitted by Colin Preis, Owner of AMADA Senior Care specializing in Transitional Care.
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