Thriving in a Value-Based Environment: 5 Post-Acute Trends Shaping the Landscape
Post-acute care is a vital component of a patient’s healthcare journey. Between 2008 and 2013, the number of Medicare patients transitioning from hospitals into post-acute care increased by nearly 5 percent. The importance of post-acute providers, who are responsible for helping patients safely return to their normal lives after a hospital stay, increases as healthcare continues its shift from payment-centered to patient-centered care. We took a closer look at some of the biggest trends impacting post-acute care today, and what these changes mean for providers in this space.
- Expanded scope of value-based care – As providers adjust to a value-based care model, it’s become clear that reducing costs per episode of care is much too narrow of a view. With this approach, providers may rule out more expensive care, even in instances where it is most beneficial to the patient. For example, severe stroke patients are often sent to a skilled nursing facility instead of a more expensive—but potentially more appropriate—intensive care unit of an inpatient rehabilitation facility.
- Increased penalties for readmissions – Healthcare facilities are now facing larger fines for high rates of 30-day readmissions—and with good reason. Readmissions are costly, nearly doubling the average Medicare payment for a patient readmitted during a post-acute episode. In 2016, Medicare penalized 2,597 hospitals for higher-than-expected readmissions, withholding the highest amount of reimbursements than any other year. With many adverse events occurring during the transition from acute to post-acute care, it is critical that providers in both spaces work together to achieve optimal patient outcomes.
- Baby boomers with multiple chronic conditions – Higher quality care isn’t only necessary for reducing readmissions, but also for caring for a new population. Baby boomers, the second-largest generation, are beginning to utilize healthcare services at high rates. People aged 65-plus are three times more likely than other Americans to have multiple chronic conditions. Additionally, Medicare reported that 93% of its spending goes to beneficiaries with more than one chronic condition. With complex, coinciding health needs, boomers cannot afford to have disjointed care. Yet, their multiple issues can almost guarantee that they see numerous providers, thus increasing their risk for conflicting and redundant services.
- Increased standards for preferred networks – The first step to improving care is to coordinate it. The benefits, particularly among complex patients, is reduced readmissions and improved outcomes. ACOs are just one way that healthcare providers are partnering to share responsibility for every aspect of patient care. Striving toward the Triple Aim, ACOs and Physician Organizations will continue to refine their post-acute networks, necessitating that those providers improve quality and lower costs in order to gain preferred status.
- Patients advocating for their own care – All over healthcare, patients are getting smarter about where they receive their services. With the open marketplace introduced by the ACA and the increased choice touted by the new administration’s healthcare bill, patient consumerism and patient choice are becoming standard. With the ability to knowledgably shop for the best care at the lowest costs, patients and their families are taking control of their health. Post-acute providers have the opportunity to assist patients with navigators and advocates ready to give valuable and honest information to help consumers make the best choices for their health.
Now what? Implications for providers
Riding the waves of change in healthcare is not always easy, but is certainly necessary in order to improve outcomes and care quality. Post-acute providers will have to work more collaboratively with acute care to accommodate a changing patient landscape and to advocate for the needs of the industry. Staying ahead of the curve requires a big-picture view and fresh, innovative solutions. Through often intimate and prolonged contact with patients, post-acute care providers have the unique opportunity—and responsibility—to push the healthcare industry even further toward a whole-patient approach.