Author: Vincent Fedele
Since the onset of the national “healthcare reform” movement, industry pundits have used historical SNF data to explain variations in post-acute episodic spend and outcomes, often applying questionable “case-mix adjustment” factors to improve performance optics. Non-comparable reporting was used to pursue business development opportunities (increased referrals) and process improvement initiatives. While I agree that SNF data can effectively “quantify” the “qualitative” measures of patient care, most marketplace applications do not offer the necessary variable sensitivity to accurately differentiate provider value.
Part of the challenge for SNF operators is organizing both clinical and financial data in a meaningful way that can display the facility’s value proposition and provide critical insight into process weaknesses and gaps in care. Adding different risk adjustment calculations and a variety of different data sources to the mix further complicates the ability of an SNF to understand and market their “data profile.” The UB-04 is the single most effective document to demonstrate an SNF’s value proposition, offering a complete picture of the resident, including demographic information, inpatient utilization metrics, physician identifiers and ancillary costs.
Medicare claim data can be effectively used to model episodic costs by independent variable and go beyond reporting simple averages. For example, you may know your facility’s average Medicare episodic cost is $10,500, but can you tell your referring ACO your average Medicare episodic cost for an 83-year woman admitted post-knee replacement with diabetes after a six-day hospitalization? Further, can you compare your performance to a blended county average, or to a specific SNF competitor based on referral source and clinical cohort? This is the granular level data necessary for success in a value-based world.
New payment initiatives (both risk-based payment programs and the Patient-Driven Payment Model) are dramatically changing the way that we do business. The industry desperately craves “Next Generation Analytics” – data specificity required for actionable “episodic” intelligence – in order to be best positioned within the context of healthcare reform. Information that displays dynamic comparative and predictive outcomes at the tertiary diagnosis level, in “real time” (and not 12 months old). Possessing and marketing this level of data to acute referral sources will help establish a sense of data sophistication and awareness that the industry so desperately requires.
Healthcare is local, so while understanding where you stand with respect to national benchmarks by clinical cohort (reported below) is important for general benchmarking, detailed metrics at the regional level are more helpful in accomplishing our financial and clinical goals.
*Based on CORE’s review of closed admissions in the CMS SNF LDS file from CY 2017