We attended the American College of Health Care Administrators (ACHCA) Convocation 2016 in Philadelphia this week. My colleague, Jennifer Leatherbarrow and I presented a session to the membership on Untangling the Web of VBP – and all of the many acronyms therein. The presentation itself is meant to break down each of the components and programs within the Value Based Purchasing initiatives from the Centers for Medicare and Medicaid Services (CMS).

During the presentation we fielded a lot of great questions, and despite the fact that it was an 8am session, we had a very interactive session with a lot of comments and questions. We spent some time discussing the CMS Five Star Quality Rating system, and how it will factor into the ability to participate in the programs as a preferred partner. A rather unhappy attendee commented that the Five Star rating system is not a completely objective measurement of a facility’s worthiness as a participating provider. To their point, I can see how it may seem to be a subjective measure – dependent on the objectivity of the surveyors. However, in the end it is all determined by data – and data is, by its very nature, objective. Yes, 70% of the star rating is dependent upon past survey results and surveys are conducted by people – there may be some room for subjectivity there, but realistically, not that much.

CMS Five Star Quality Rating System

For the Five Star rating, points are calculated using the facility survey results (including complaint surveys and re-surveys) over the prior three (3) years; 35% most recent, 23% second most recent and 12% third most recent. In order to improve this metric, a provider must improve their survey scores.

Additionally, direct care staffing is a component of the Five Star rating. Gone are the days of staff to resident ratios – now the measurement is looking at the resident acuity to determine appropriate staffing levels.

On top of the survey results and staffing, Quality Measures are factored in. Recently CMS added five (5) more quality measures plus one (1) that will not factor into the star rating at this time. This brings the total to eleven (11).

Some providers may feel that this is an insurmountable challenge. Others may feel that the government wants to force them out of business. While CMS has stated that the goal of VBP is to improve the overall quality of care, there is equal emphasis on the goal to decrease costs and protect the Medicare trust. But with strategic planning, providers can work towards both goals simultaneously.

There are Five Star facilities out there. Reach out to them. Ask them how they were able to achieve this status. Perhaps they will have ideas that can be implemented in your community?

One administrator told us that they have replaced the position usually allocated to a social worker with a Nurse Case Manager. This person not only works to ensure that the clinical staff has a complete plan of care for the resident, including a comprehensive discharge plan; they provide oversight to make sure that the plans are being followed. This case manager will contact every discharged resident on a weekly basis for 45 days post-discharge - they not only monitor how the former resident is coping with medications or additional therapy with a home health agency but through this process they may be able to identify potential issues and implement clinical interventions in order to avoid unnecessary re-hospitalization.

The key to success with any of the programs that are part and parcel of Value Based Purchasing is education. Rather than gnashing our teeth and raging against the machine, we need to approach this new landscape with an open mind so that we may recognize the opportunities for success.

For ideas on how you can improve your quality rating, contact Richter Healthcare Consultants to request a free consultation to learn how we can help.