The Affordable Care Act provided a clear wakeup call to long-term and post-acute care (LTPAC) providers that they had to do a better job of measuring and reporting on quality. Looking ahead at 2016, both provider organization executives and software vendors say their efforts will continue to shift from using data analytics to maximize reimbursement under the fee-for-service system to a focus on achieving better outcomes and partnering with others in the care continuum.
As acute-care hospitals are taking a data-driven approach to post-discharge efficiency, comparing post-acute providers based on clinical and operational performance metrics. With the penalty structure in place for preventable readmissions, they can’t afford not to.
The transition to value-based payment is shifting the conversation to the measurement of success, according to Steven Littlehale, chief clinical officer at Cambridge, Mass.-based PointRight Inc., which provides predictive analytics services to post-acute providers.
That type of measurement, however, has never been a strong point of the skilled nursing facility (SNF) sector. “To this day, we do not know how much it costs to care for certain patient types within our SNF environments. We have no idea,” Littlehale says. “That is just one example of how the absence of data has been such a long-term issue in our industry. We can’t demonstrate the value we have. We can’t demonstrate we are an exceptional provider of care.” But these days, he adds, you must have the data to justify your existence.
Providers today need to know how they perform on outcome measures relative to peers and national benchmarks, notes John Damgaard, CEO of Bloomington, Minn.-based MatrixCare, an electronic health record (EHR) provider for the LTPAC setting. “More importantly, if they are failing in a particular area, why is that? Overall prescribing of anti-psychotics might be OK, but if you dig down and region one of nine is off, then you can drill down to line of service, and see that it is one doctor who seems to be prescribing 10 times more than anyone else.”
Regarding the shift in relationships with hospitals, Damgaard says one LTPAC customer put it to him this way: “Five years ago we used to take flowers and cookies to the hospital to get their referrals. Now we take our charts and graphs. Tomorrow we’re going to take our contract lawyers, because we are going to be signing into bundled payments and other types of capitated arrangements with our partners in the spectrum of care.”
Retrospective vs. real-time data
Now that many providers can pull clinical data from the EHR, they are starting to access data that is fresher than the retrospective information provide by the Centers for Medicare & Medicaid Services. “We believe the data has got to be near real-time,” Damgaard says. “It is kind of interesting what happened 60 days ago, and it might help shape behaviors and improve processes, but 60 days is a long time in today’s world. You may have spent a quarter-million dollars of margin you didn’t need to spend in the last 60 days just in one practice area.”
Littlehale stresses that providers need both retrospective and near-real-time data. For quality improvement analysis, it doesn’t matter if your data is six months old. “The data is not changing that dramatically,” he says. If you look at re-hospitalization rates over the last year, you are not going to see a lot fluctuation. Any downward trend is going to be slight at best, and that is just the nature of this kind of data. “But when it comes to moving the needle, you need real-time data,” he added. “If you are trying to make changes at the bedside or decisions about acquisition or divestiture, having real-time data points can help you make better decisions.”
In general, Littlehale says, LTPAC providers have made gradual progress. “I think we are maturing to realize that there is a difference between data and analytics and a difference between analytics and insight. But if you think of that as a hierarchy, most providers are at that bottom level, saying OK, I need to have data.” But having that data is not insight. “That requires someone to manipulate the data to have these aha moments, and the majority of people in the SNF space don’t have the skills to manipulate the data, let alone case-mix adjust it and come up with the appropriate benchmarks.”
Some provider organizations turn to outside help for benchmarking. For instance, The Advisory Board Company’s SNF Benchmark Generator tool is designed to help member SNFs position themselves in terms of relationships with health systems under bundled payment, so the main areas in the benchmark generator focus on utilization and financial metrics: length of stay, payments and volume.
“Depending on how the organization wants to initiate the conversation with the hospital, this tool gives our members the ability to benchmark against a cohort of post-acute providers on length of stay,” says Jared Landis, an Advisory Board practice manager. “They can tell hospitals ‘we are cognizant of length of stay and not abusing the Medicare system. We are keeping them an appropriate amount of time, as measured against the cohort.’”