Few can diminish the tumult and upheaval that await the senior living over the next three years. There’s a new four-letter word to describe it: Data.
The pressures couldn’t be greater. Though hospitals have been heavily scrutinized and penalized since 2012 for 30-day readmissions under the Affordable Care Act, 2017 promises to see thousands of others join the fray as the Centers for Medicare & Medicaid Services adds more and more reasons to reduce payments. Even as you’re reading this, many continue pouring over the mountain of changes the agency has in store.
Many, if not most, of those readmissions are coming from the long-term care side.
“Hospitals, clinics and accountable care organizations all over the nation are really putting pressure on facilities out there to have good rehospitalization rates, shooting for 10% or less,” said Dan Billings, vice president of business development at Pathway Health. “The readmissions piece is an indicator of so many different things — good nursing and clinic practice and recognizing disease states early.”
By 2018, CMS hopes to have met its ambitious goal of having at least half of all Medicare payments tendered through alternative models such as accountable care organizations. And by 2019, CMS will launch its much ballyhooed value based purchasing program, which will reimburse providers based on the quality, not quantity, of care pay.
For decades, senior living providers have been looked on as the final stop in the human journey from health and wellness to end of life. But no more. In the coming years, providers and operators will be held as accountable as doctors and hospitals for improving outcomes. Data will be at the heart of their survival.
But as experts observed, despite all of their investments in information technology, senior living providers are woefully behind the curve in mastering data to compete in the emerging world of performance-based care. As one leading consultant observes, winners will be those who are looking as much at their windshield as their rearview mirrors.
Of course, the morphing inflicted by ACA should ring familiar with healthcare executives who were around two decades ago. “When it went from cost-plus to prospective payment, the industry just imploded,” said Steve Scott, CEO of PointRight. “They couldn’t unwind quickly enough. They didn’t know how to manage their costs.”
“You get the same feeling when you talk to executives today — they remember that time very well,” he added. “They want to know how to get ahead of that curve now.”
To many, including Scott, operators are again fighting an uphill battle. “We are at a point in the industry of being behind the power curve,” he said. Unlike the retail sector, which quickly embraced new models, the internet and IT technology, healthcare is still connecting the wires. “Before, we were a brick-and-mortar business. We put heads in the beds and focused purely on taking care of people,” he added. “Now it’s become way more sophisticated.”
Looming changes are fueling more questions than answers. “Value-based purchasing is scaring a lot of people. And it’s scaring not only the operators, but those who financially support them,” Scott added. “If you have Medicare receivables, they’ll loan you based on 95% of it because it’s almost a guaranteed payment. All of a sudden that’s all changed. It’s no longer a guaranteed payment because you have to prove you created value.”
DEALING WITH ‘DIRTY DATA’
Even though more and more operators are investing in sophisticated IT systems and electronic health record platforms, the old ‘garbage in, garbage out’ cliché still has relevance. And Scott has seen his share of “dirty data.”
“EHRs can standardize all of this information, but if people are still filling out the elements in that EHR incorrectly, then your results are going to be skewed,” he said. Filling in the gaps can be an exhaustive endeavor. “We’ve seen within the MDS where a patient was bed-bound but in another section is described as ambulatory,” he adds. “These kinds of conflicts can throw off their quality measures, and present [an operator] as not performing correctly.”
Larger senior living chains have their own unique issues as well. “They may have bought 20 facilities from six different owners and are wrestling with different EHRs as well as paper and are trying to find a true operating picture of their portfolio, both clinically and from a business performance perspective,” he said. Data integrity issues can doom any efforts when it comes to root cause and predictive analytics. “You have to have a method to ensure the data you captured is accurate, or clean,” he added.
As McKnight’s Senior Living reported earlier this year, assisted living professionals seem to be answering the call to action. In its 2015 performance measures survey of them, the National Center for Assisted Living found that nearly 97% had established mission statements for quality improvement, and almost 83% had quality assurance or improvement committees in place. It’s a start. Here are some key success factors.
• Perform data discovery. “If you look across the spectrum, gathering data is a challenge, because it could reside in a paper chart, an electronic record, your pharmacy, your lab or the info that comes back from CMS, so it’s in these disparate silos,” says Scott. “And so data discovery is a meaningful exploration of data.”
• Know how to harness your EHR system. “Having an EHR to track care and quality outcomes will be table stakes,” said Mark Woodka, CEO of OnShift. “The more data that a senior living provider can offer to prove quality will not only be beneficial, but it will also become an imperative.” Jason Principe, segment marketing manager, Senior Living for PointClickCare, said he believes it is at the core of providers’ future success meeting performance benchmarks. “An EHR is fundamental when it comes to telling the resident story,” he said. “When the right people have access to the right information at the right time — and can act on it without delay — they can make better care decisions and promise safer transitions of care.” Pathway Health’s Dan Billings agreed. “Operators really have to be at the top of their game in terms of nursing and have the systems in place in order to recognize and catch things early,” he said. “Because most EHRs integrate rehospitalization practices, those processes can assist with decision support. In terms of quality assurance and performance improvement [QAPI], they can dive into that ocean of data and pull out value and see what their trends are, spot problems early, and react much quicker.”
• Have a plan. “Companies that successfully use their data are the ones that have a vision and purpose of what they want to drive with data,” Scott said. “They usually have some type of data governance. The key will be predictive analytics and data-driven decision support because value-based purchasing is changing that revenue stream.”
• Ensure adequate resources. “Staffing must not be overlooked when determining key performance indicators and demonstrating measurable value to network partners,” Woodka said. “Those organizations that can prove that they staff consistently and drive high retention will have a competitive edge while delivering quality care and service.”
• Understand your partners’ expectations. “One thing senior living operators need to do when partnering with a hospital or ACO is knowing what data they are interested in,” Billings said. “Because for now, they have the power in the relationship. Successful providers go to the table and listen to the hospitals and ACOs on the quality indicators and data items that they are requiring.”
• Know what to look for. In her recent column for sister publication McKnight’s Long-Term Care News, Cheryl Field, chief product officer for Prime Care Technologies, urges providers to “find value in your data. The Five Star pressure still lingers — with three or more stars required for marketability across managed care organizations, ACOs and acute providers beholden to bundling.” Billings said community health data are a key place to start. “Certain specific quality indicators are just beginning to engage,” he said. “There’s community health data that allows you see which diagnoses are flowing out of the hospitals and you can see from that data where people are going. If you can sift through the data as an operator, then you will know where you fit in.”
• Change your mindset. Robert Choi, chief strategy officer for Collain Healthcare LLC, a LG CNS company, urged senior living operators to begin thinking like their partners. “They need to have a data strategy that aligns with their care delivery strategy,” he said.