Use Upcoming ADT Rule to Rethink Your Care Game
Although the timing may still be up in the air, Skilled Nursing Facilities (SNFs) and other post-acute care and Long-Term Care providers should be preparing for a deluge of ADT notifications from hospitals.
The Centers for Medicare & Medicaid Services (CMS) is requiring that hospitals provide admission, discharge and transfer (ADT) notifications to post-acute care providers as part of their Conditions of Participation (CoP) to receive federal payments. The original deadline was Jan. 1, 2021, but the global pandemic has caused that deadline to slip until May 1, 2021 — barring another delay.
The value-based care trend has been gaining momentum over the past several years, and a new survey indicates that the pandemic will do nothing to slow that momentum. Forty percent of respondents believe the pandemic will propel the industry away from fee-for-service and more toward value-based care. That sentiment was expressed by hospitals, payers and physician groups.
Rather than treat this as another government mandate that creates more red tape, SNFs and other post-acute care providers should seize this opportunity to rethink their ADT processes and their relationships with referring providers, primary care physicians and others involved in patient care.
Errors occur at the point of transfer
The movement of patients among care settings can be fraught with error as patient information, medications, continuity of care documents (CCDs) and other data is supposed to accompany the patient. An estimated 80% of serious medical errors can be traced to miscommunication among caregivers at the point of transfer between care settings. The same communications breakdowns can delay treatment, cause inappropriate treatment or lengthen hospital stays that could bring federal penalties.
To be effective, both the sender and receiver of information should be on a common communication platform so data can be easily transferred. But that’s not always the case, amid differing EHR or patient information systems used by hospitals, physician groups, SNFs, behavioral health centers and other providers.
A study published in 2018 that focused on 10 academic medical centers showed that 36% of readmissions within seven days of hospital discharge were preventable, while 23% between days eight and 30 were preventable.
The importance of understanding the entirety of a patient’s health and co-morbidities — not just the acute condition — plays a critical role in readmissions, a multinational study indicates. The study looked at hospitalizations for 12 chronic conditions, then tracked patients post-discharge. Between 30%-70% of readmissions were for conditions not directly related to the initial hospitalization, most commonly infections and treatment-related complications.
It’s no wonder that federal payers want to increase care coordination through ADT.
What to look for in an ADT solution
Penalties associated with the Skilled Nursing Facility (SNF) Value-Based Purchasing Program have been temporarily suspended during the pandemic, but operators face a 2% reduction in Medicare payments for failing to meet minimum standards for reducing hospital readmissions.
Consequently, SNFs have a large incentive to connect with referring partners upstream and downstream to ease transitions of care that can bring readmissions. The fax machine still rules healthcare communications, but technology-driven solutions such as ADT alerts or notifications can reduce both cost and the potential for human error. Such solutions have been shown to reduce patient readmissions by up to 18%.
SNFs need technology that provides comprehensive interoperability and streamlined workflows to keep facilities connected through the continuum of care. Ideally, alerts will not be one way from hospitals to SNFs. Rather, alerts should flow bidirectionally across all care touchpoints. The primary care physician (PCP) plays an oversized role in care delivery, but the PCP often is the last to know when a patient is admitted to the hospital or discharged home or to a post-acute care facility. That’s why any technology should be able to interact with other providers through regional directory services.
Alerting must fit into a provider’s workflow to benefit patients and support care transitions while reducing the incidence of alert fatigue that can occur in healthcare settings. Look for solutions that feature standard HL7 ADT message support, direct messaging and configurability for other types of notifications. Depending on existing technology, SNFs may want alerts in different formats, including CCD, XML, PDF and text, so any solution should support multiple outputs. A configurable alert dashboard provides central monitoring of alerts and customization options to differentiate among various alert types.
Conclusion
Skilled nursing facilities provide a critical link on the continuum of care, especially as hospitals face continued penalties for readmissions and adopt more value-based care contracts that shifts the financial burden more onto providers. The transitional nature of SNFs means that facilities likely have not seen these patients before, making care transitions vital.
As CMS mandates ADT systems from hospitals to post-acute care providers, leaders at skilled nursing facilities should look closely at their technologies and workflows to make receiving ADT alerts an important part of the care process. The result should be better patient care, fewer readmissions and closer relationships with referral partners.
Brenda Hopkins serves as Chief Health Information Officer for J2 Cloud Services.