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Creating a Network of High‐Quality Skilled Nursing Facilities: Preliminary Data on the Postacute Care Quality Improvement Experiences of an Accountable Care Organization
Author(s) -
Lage Daniel E.,
Rusinak Donna,
Carr Darcy,
Grabowski David C.,
Ackerly D. Clay
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13351
Subject(s) - medicine , payment , quality (philosophy) , health care , patient satisfaction , skilled nursing facility , nursing , family medicine , business , philosophy , finance , epistemology , economics , economic growth
Postacute care ( PAC ) is an important source of cost growth and variation in the Medicare program and is critical to accountable care organization ( ACO ) and bundled payment efforts to improve quality and value in the Medicare program, but ACO s must often look outside their walls to identify high‐value external PAC partners, including skilled nursing facilities ( SNF s). As a solution to this problem, the integrated health system, Partners HealthCare System ( PHS ) and its Pioneer ACO launched the PHS SNF Collaborative Network in October 2013 to identify and partner with high‐quality SNF s. This study details the method by which PHS selected SNF s using minimum criteria based on public scores and secondary criteria based on self‐reported measures, describes the characteristics of selected and nonselected SNF s, and reports SNF satisfaction with the collaborative. The selected SNF s (n = 47) had significantly higher CMS Five‐Star scores than the nonselected SNF s (n = 93) (4.6 vs 3.2, P < .001) and were more likely than nonselected SNF s that met the minimum criteria (n = 35) to have more than 5 days of clinical coverage (17.0% vs 2.9%, P = .02) and to have a physician see admitted individuals within 24 (38.3% vs 17.1%, P = .02) and 48 hours (93.6% vs 80.0%, P = .03). A survey sent to collaborative SNF s found high satisfaction with the process (average satisfaction, 4.6/5, with 1 = very dissatisfied and 5 = very satisfied, n = 19). Although the challenges of improving care in SNF s remain daunting, this approach can serve as a first step toward greater clinical collaboration between acute and postacute settings that will lead to better outcomes for frail older adults.