How Dwelling Well being’s value-based buying mannequin might additional cut back nursing dwelling occupancy

As patients continue to look for opportunities to receive care at home across more institutional settings such as nursing homes, an upcoming nationwide rollout of the Home Health Value-Based Purchasing (HHVBP) model could erode managed care relationships leave and further remove care from SNFs.

Results from a five-year HHVBP demo in nine states showed a 0.34 percentage point decline in SNF use per year among home health care beneficiaries.​

This represents a 6.9% decrease in average readings compared to the pre-HHVBP implementation, as previously reported in sister publication Home Health Care News.

An annual assessment of the model recognized the SNF decline, prepared and published in April by the Arbor Research Collaborative for Health and L&M Policy Research.

Brian Fuller, CEO of Integrated Care Solutions, a care management and care coordination company, told Skilled Nursing News that the model’s main impact on the industry is that fewer, if not as many, patients will be eligible for a nursing home stay are hospitalized again – one of the quality indicators of the HHVBP.

“It changed their care patterns in such a way that the frequency of patients cycling through the system decreased and therefore not as many people were readmitted to hospitals and there were not as many patients who were eligible for later SNF residency . ‘ Fuller explained.

HHVBP prevented that cycle from continuing at the same rate as in markets where the model wasn’t tested, he added.

“What these programs do, which I think is their intent, is they create this hyper focus on the quality metrics… it causes [clinical leaders] to rethink the way they provide care,” Fuller said.

The report also found that during the first few weeks of a home health episode, visits to qualified nurses and therapy increased, another important finding for SNF operators, Fuller noted.

The process is known by homecare facilities as “front-loading” when a large proportion of visits occur within the first few weeks of a 60-day homecare episode.

“We know from experience that starting care within 24 to 48 hours and frontloading this home healthcare episode tends to result in a smoother transition of care and stabilizes the patient,” he said. “Home health has a big impact on when [patients] start care how they allocate the visits via home nursing.”

The HHVBP implementation also resulted in $201.2 million in Medicare savings specifically associated with SNF use between 2016 and 2020, according to the report. This is an average decrease of 4% in SNSF service spending.

If a nine-state demo can save $201.2 million in Medicare dollars that would normally be spent on SNF stays, a 50-state model could drain hundreds of millions — or billions — from institutional care facilities for years to come . This could be a significant consequence of macro-level value-based shopping if the trend continues into 2023 and beyond.

“The decrease in overall Medicare spending due to HHVBP continues to be driven largely by cuts in inpatient and SNF service spending among home health care beneficiaries,” the report’s authors affirmed.

Average Medicare spending per day on inpatient services decreased 2.8%, representing savings of $546.8 million. According to the report, the Medicare model saved a total of $949.2 million.

The report also found that HHVBP plans saw an increase in short-stay patients with heart failure and especially knee and hip replacements, which in turn led to a decline in SNF use for these types of patients.

The authors specifically pointed to the three-day residency requirement as a factor in this shift of short-stay patients from SNFs to home nursing care, although the requirement was lifted as of 2020 due to the public health emergency (PHE).

Next year is scheduled to be a “benefit year” for expanding the HHVBP model to 50 states, according to the Centers for Medicare & Medicaid Services (CMS), while 2025 will be the “payment year” in which home health care participants receive a payment Adjustments based on performance quality measurements.

For nursing home operators, such statistics could reshape the landscapes of post-acute and long-term care as policymakers and the Biden administration continue to advocate for home care while pursuing sweeping reform of the SNF sector.

“Our findings that HHVBP reduced unplanned hospital admissions, ED intakes leading to inpatient admissions, and SNF intakes are consistent with policymakers’ intentions to stimulate HHA activities that reduce unnecessary acute care utilization,” the authors said.

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