Q: The Centers for Medicare & Medicaid Services has announced a new mandatory bundle program for hospitals, starting in 2026. It will change how providers are paid for surgeries and care in the 30 days following lower extremity joint replacement, surgical hip or femur fracture treatment, spinal fusion, coronary artery bypass graft and major bowel procedure. How can nursing homes prepare?
A: Step one is finding out: Am I in one of the markets? Step two is really looking at, for these five conditions — and really the orthopedic conditions will be the most focused on — where are they getting referrals, and how important is that to their bottom line?
Q: Are skilled nursing providers doomed to lose even more business with this TEAM program?
A: That’s a potential risk, but I think the biggest one is probably the hip and femur fracture repair, where 63% of spending happens after patients leave the hospital. For a lot of SNFs, they get pretty decent volume from that and the margins are relatively strong. That’s a point of exposure.
Q: You’ve said data will be critical for SNFs that want to get involved in the model’s risk-sharing through collaboration. Will hospitals in the 188 chosen markets automatically turn to post-acute partners?
A: SNFs can be a preferred partner with a hospital [but] it’s going to have to be the SNFs who are going to the hospitals to collaborate. The sooner the better there because the hospitals are looking to get the surgeons or the physicians on board. There are opportunities, but if the SNFs are waiting for the hospitals to come knocking, it’s just not going to happen.
From the September 2024 Issue of McKnight's Long-Term Care News
