Turning CMS’ Guidelines into a SNF Playbook

The Centers for Medicare & Medicaid Services (CMS) announced in July they will be changing the way they evaluate skilled nursing facilities (SNFs), now focusing on four measures instead of one. Since October 1, SNFs across the country are being evaluated on their 30-day hospital readmission rates, the number of hospital-acquired infections, overall nurse staffing levels, and staff turnover. Poor results of the evaluation could result in penalties or reduced incentives. CMS also noted that the perspective payment system (PPS) base rate will rise by 3.2%. 

These changes put skilled nursing facilities further in the spotlight than they already are and add even more pressure, forcing outcomes and workforce stability as a core part of how CMS determines their value based care-based incentive payments. Given that staffing and turnover can have a large impact on patient outcomes and hospital readmissions, these updated guidelines are a good opportunity for SNFs to change how they operate moving forward. Those who start implementing new policies and objectives soon and begin to operate as one system, rather than prioritizing each outcome separately, will be the ones to see the greatest results.  

Changing operations to make a difference 

No organization or facility, large or small, can completely change the way they operate overnight. It can often take months, or even years, for new processes to be decided upon, shared with teams, and officially rolled out. Unfortunately though, time is limited for SNFs to make these changes. Here are three processes that SNF leaders should implement into their workflows immediately to kickstart an organizational shift. 

1. Make readmission prevention a priority and a daily habit. Online platforms such as electronic medical records, and the additional tools that work alongside them, can be an important resource in readmission prevention and should be frequently leveraged by SNFs. AI within these platforms can be used to scan provider progress notes, vitals, labs, medications, therapy regimes and social work notes to automatically flag patients who are at risk of a readmission or showing early signs of deterioration, allowing them to be monitored more closely. Patients recently admitted to the SNF, those with underlying conditions such as COPD, as well as anyone who has had a notable decline in their health within the last week should also be marked as a high risk and closely monitored. In addition, effectively coordinated management of transitions out of the facility is essential to reducing the potential for readmissions post discharge. SNF staff should confirm with patients and primary care physicians that there is a follow up appointment scheduled shortly after discharge to ensure there are no further complications. SNF staff should also provide a minimum of one virtual check-in with patients within 48 hours of discharge to check their symptoms and ensure any remote monitoring tools, if used, are working efficiently. 
2. Treat infection management as a readmission measure. Patients admitted into facilities are often vulnerable to infection, especially those who may be unable to move around themselves. Regularly scanning for signs of urinary tract infections, pneumonia and wound deterioration can allow staff to provide effective interventions prior to infections endangering the patient. Staff should closely monitor any medical devices or tools such as central lines or urinary catheters and remove them in a timely manner if no longer needed. If an infection were to arise, it is critical that SNF staff have a direct line of access to an onsite medical director or nurse practitioner for same-day evaluation to prescribe necessary medication quickly and prevent a hospital readmission.  
3. Stabilize staffing to stabilize outcomes. Unfortunately, many SNFs will see most of their avoidable events occur overnight and over the weekend, often when most team members are off duty. Leaders should optimize their staff by initially utilizing their most effective and experienced staff during these shifts and then build the remainder of the schedule around it. Human resources and other leaders within the facilities should also leverage data and feedback to retain their staff. While exit interviews can provide insight into what went wrong during an employee’s time at the company, regular check-ins can provide real-time feedback and are much more beneficial. These informal conversations can occur as often as once a month or even once a quarter and can provide leadership teams with an insight into workloads and scheduling, helping to detect burnout or any declines in job satisfaction before they lead to turnover. 

Though these new CMS guidelines may seem overwhelming at first for SNF leaders, they could serve as a motivation to improve efficiency across the board. CMS is not asking for skilled nursing facilities to be perfect. There will always be events that are unavoidable, even with the best staff on hand, but making the effort to implement small changes into daily practices will go a long way. Prioritizing readmissions and patient outcomes while also ensuring that employees are satisfied will not only help to comply with the CMS evaluation guidelines but will ultimately lead to better outcomes for the organization and its patients.

Photo: Wavebreakmedia, Getty Images

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