Post-Acute Care: Build a Top-Performing Network

Step One: 3 Years Claims Data

You will need access to 3 years of Medicare claims data. If you are an ACO you have that data readily available. If not you have options such as Medicare Blue Button and Medicare Data at Point of Care.

Step Two: DRG Level

The data then needs broken out into DRG level encounters

We refer to each episode of care analysis as a mini ACO because it is one defined diagnostic-related group (DRG) (or grouping of ICD 10 diagnosis codes) within an ACO. You can break your Medicare Part A spend into each of these DRGs and have multiple mini ACOs that break down the spend and trends.

Step Three: Post-Acute Care (PAC) Provider Analysis

The goal is to rate each PAC provider using the claims data based on length of stay, cost per day, rate of complications, emergency department visits and re-admissions. Then stop referring to poor performers until the entity can demonstrate change.

Step Four: Discharge Protocols

The next step is to review your discharge protocols. What determines the patient’s discharge location?

SNF vs. Home Health vs. Self-Care?

Performance Opportunity

• Reduce post-acute provider spend (e.g., discharge to home care instead of home health or discharge to home health instead of SNF.)
• Build a post-acute provider network based on quality performance using your PAC analysis above.
• Using your PAC provider review, find the root cause of complications and poor care in post-acute provider network.

Step Five: Complications Trending

Which providers (surgeon, SNFs, HHAs) are the root cause of patient complications?

What patient outcomes are related to complications; (e.g. patients not being screened and or eligible for surgery; patient self-care not being managed)?

Performance Opportunity

Screen patients for surgery eligibility.

Performance Case Study Results

Hospital now sends 40 percent of all hip and knee replacement patients' home after surgery, up from 15 percent previously.

Hospital now sends 20 percent of all hip and knee replacement patients to home health after surgery (instead of SNF), up from 10 percent previously.

Hospital reduced SNF network from 15 to 7 with Length of Stay (LOS) dropping by more than 9 days.

Hospital reduced complications by 18% by changing post-acute care network utilizing historical data of infections, poor care, and length of stay analysis.

Kris Gates | Health Endeavors | Patient Lookup | RPM Devices | 480.659.8130 | gates@healthendeavors.com