Skilled nursing facilities earning the highest rates under the Patient Driven Payment Model aren’t necessarily bringing in the most referrals, a new analysis finds.
The data experts behind the research said last week they were surprised to learn that high quality measures and higher reimbursements weren’t necessarily linked to referral quantity.
“In most cases, there were no glaring reasons why these SNFs should not be getting more [Medicare] Part A referrals from their top hospital,” said Sarah Scott, senior client success coordinator for long-term care software provider Simple.
During “Rock Your Referrals: Building A Rockstar Referral Strategy with Your SNF Data,” Scott presented solutions facilities can use to improve data collection and develop stronger relationships with referral partners. Scott also suggested internal solutions, such as gaining a better understanding of the other places facility physicians are practicing and what they are doing to maintain referral partnerships.
“The data is everywhere, and it is overwhelming how much data is available for SNFs,” Scott said. “But picking and choosing your focuses and using all the data will really help us result in some better referral positioning and translate into better reimbursements so shifting that strategy from a ‘hope for the best’ approach to a data-driven approach [will benefit facilities].”
Scott dispelled several common myths about referrals, such as believing that a facility’s proximity to a referring facility is a primary factor, lower readmission rates will automatically result in more referrals, and 5-star rated facilities will “always” get more referrals.”
Scott stressed that the more successful facilities use quarterly Limited Data Sets from CMS to examine quality measures and understand where they excel. Lower readmission rates don’t necessarily disqualify providers from going after more referrals for certain conditions. A a facility that specializes in cardiac care, for instance, may have a lower star rating or a higher readmit rate that aligns with the seriousness of those diagnoses and the complexity of the patients’ needs.
The five most important areas to benchmark when analyzing internal data are compliance, PDPM categories, end splits, quality measures and referrals, Scott said. The most common PDPM errors are related to speech-language pathology, and Simple estimates that 38% of errors occur in this category, followed by non-therapy ancillary costs.
The webinar also stressed the importance of ICD-10 coding and that it must be consistent across the minimum data set, electronic health records, and claims. The primary diagnosis may not be the same as why a resident was admitted, Scott said.
“Hopefully, utilizing the data that you have at your disposal and the data your facility collects and that you know how you’re providing care, what your readmit rates are, and what your referral partnerships are will affect what your referrals are into your skilled nursing facility,” Scott said. “Turning that information into opportunities to build and maintain your status and really showing the collaboration of disciplines and data will position you to have higher reimbursements, higher referrals, and overall, more success as a skilled nursing facility.”
