Changes to Healthcare that Impact Rehabilitation

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There is a tremendous amount of disruption within the marketplace. Innovation, industry reform, and better-educated consumers impact how we provide services. Healthcare reform is not something new. But, the rate at which it is happening and the breadth of those changes are impacting rehabilitation services to a greater extent.

Medicare is looking for ways to improve upon the current system. In 1998, the Prospective Payment System went into effect for skilled nursing facilities (SNFs). Since then there have been many voices calling for an improvement in the reimbursement model – one that will promote individualized care for residents using patient characteristics and their specific needs to ensure the most accurate payments for services. Numerous agencies, demonstration projects, and consultants have spent quite a bit of time reviewing and testing all different types of modifications to our current plan.

First, there are mergers and consolidations. Again, this is not something that is brand new. But the pace has certainly increased. The current market pressures result in an increase in the number of healthcare organizations that are consolidating services in order to better meet the requirements for data reporting, reimbursement, and integrated networks of care. It is interesting to see the data on merger and acquisition activity among hospital groups: it increased 70% between the years 2010 to 2015, and remained strong through 2016. In fact, 2016 was a record-breaking year for healthcare mergers and acquisitions.

Why is this happening? Certainly, there is great pressure to lower costs. The cost of acquiring needed technology such as electronic medical records, and emerging technologies in surgical interventions and other life-saving techniques, has put significant financial pressure on organizations. Finally, there is pressure to use new ways, such as coordinated care continuums or preferred provider networks, to deliver health care.  These allow for more efficient patient movement through different levels of care, and save money.

For speech-language pathologists, this creates an environment of changing administrators, providers, and corporate culture. My experience over the course of 20 years in an evolving healthcare company is that when there were new providers, some of them had extensive experience with speech pathology, and some of them had very little. The quality of their experience was also highly variable; some had very positive experiences, and others not so much. Knowledge and philosophy can also be very variable within our practice. Within our field, we all have had different experiences, and have differing philosophical approaches and styles. Early meetings with new providers allow you to describe your experience and philosophy, and can help you gain trust and build relationships early on, which pays dividends later.

There is also value- versus volume-based reimbursement. This is a big deal because it is a big shift in the reimbursement approach.  Value-based reimbursement focuses on outcome measurement and paying for quality care, rather than paying for services regardless of outcomes as the fee-for-service model did in the past. This reflects a shift from “volume-based” to “value-based” care. The Accountable Care Act mandates this change from volume- to value-based care. Most of you have heard of ACOs, or accountable care organizations. ACOs are seen as the bridge from the past fee-for-service model to the current value-based system. ACOs were able to integrate care among multiple levels of providers who share a common set of quality criteria and cost definitions, based on a specific population. This shift from volume-based to value-based means that resources are shifted to the area where the most impact can be demonstrated. The shift will not just be about changing reimbursement models, but will increasingly drive how corporate decisions are made.

There are also quality changes. Quality is a measurement of resources invested in patient services that result in positive outcomes. One of the measures that receives a lot of attention is hospital readmission, and this is a very important one for speech pathologists. We know that currently, 20% of all hospitalized Medicare beneficiaries go to skilled nursing facilities following their hospital stay. Of these, 25% are readmitted to the hospital, costing Medicare 14.3 billion dollars. That certainly gets a lot of attention.  Starting in fiscal year 2018, skilled nursing facilities will be penalized for patients who are readmitted to the hospital within 30 days of their discharge from the hospital to the SNF.

The IMPACT Act (Improving Medicare Post Acute Care Transformation) establishes a uniform system of measures for reporting outcomes across all post-acute care settings. This includes home health, inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The IMPACT Act was signed into law in October 2014. It requires the Center for Medicare and Medicaid Services (CMS) to develop standardized patient assessment data on specific quality measure domains for post-acute care facilities. This standardized data allows for comparisons across these settings, and possibly for the development of one payment system across all four settings. Facilities, rather than individual providers, report IMPACT-related data. Therapists are not required to report on this until 2019, when they may be opted in, and eligible for reporting.

It is important to stay on top of these changes and how they impact your practice. Resources such as those provided by ASHA and other government agencies can give you a snapshot of what changes will impact your work.

Please refer to the SpeechPathology.com course, Justifying Speech-Language Pathology Services in a Turbulent Health Care Environment, for more in-depth information on the SLP's crtical role on the rehabilitation team in an ever-changing healthcare environment.