Payment reform is affecting physicians and facilities alike in PALTC. The role of PALTC physicians and medical directors is evolving and now requires a high level of understanding of Alternative Payment Models (APMs), the Merit-based Incentive Payment System (MIPS), the Medicare Access and CHIP Reauthorization Act (MACRA), Value- Based Purchasing (VBP), and Patient-Driven Payment Models (PDPM). It is imperative that physicians align their goals with PALTC facilities and achieve optimal outcomes for their patients while ensuring that they qualify for available payment incentives and avoid penalties. With its scheduled implementation of October 1, 2019, PDPM is the single most significant change to SNF reimbursement in nearly 20 years. Finally, avoidable readmissions of Medicare A beneficiaries has emerged as the singular indicator of unnecessary and wasteful spending of health care resources and bad outcomes. This metric defines the “Value” in Value-Based Purchasing by affecting both quality of care received by beneficiaries and the cost. This session will feature interactive clinical scenarios and two pilots designed to reduce readmissions in SNF populations. One is a Missouri Quality Initiative (MOQI) that is part of a Center for Medicare and Medicaid Innovation (CMMI) grant. The second is a Chicago-area study of six nursing homes where implementing best practices and measuring clinician compliance resulted in reducing readmissions by 25% in three months.
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