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The Power of Data to Demonstrate Value and Improve Operations


Data is quickly becoming a must-have for skilled nursing providers looking to shore up their post-acute business. Post-acute patients generally have high-acuity needs that result in higher daily reimbursements, usually by Medicare. As some hospitals and Medicare Advantage plans increasingly bear more financial risk for these patients, they will seek partnerships with providers that can demonstrate their ability to provide a high level of care and potentially avoid costly rehospitalizations. With the entry of other risk-bearing entities, such as accountable care organizations, into the marketplace, the need to demonstrate value will grow.

The need for data to make operational decisions is growing, as well. In today’s blog post, we’ll share some recent findings and point out ways that providers can use available data to understand their own pressure points and value propositions while gaining insight into how they can develop strategic partnerships with hospitals and payors.

The High Risk of Hip Fractures

HealthDay reported on an American study in the Journal of General Internal Medicine, which found that the majority of hip fracture patients over 65 never return to their pre-fracture level of function, even among patients with high levels of ability prior to incident. According to the HealthDay report, the Centers for Disease Control and Prevention (CDC) states that over 95% of hip fractures are the result of falls, which in many instances can be prevented through proper environmental controls.

Similarly, the Canadian Medical Association Journal recently published a study of Canadian hip fracture patients found that large teaching hospitals produced better outcomes than community hospitals, which experienced a higher in-hospital death risk. However, the study did not identify any major differences between the two hospital types to explain the disparate outcomes.

In a journal news release covered by HealthDay, study author Katie Sheehan said that hip fracture is almost as common among Canadian seniors as cancer, but outcomes are much worse. Sheehan said of this patient cohort, “Even after treatment, 30 percent die within a year, 25 percent never walk again and 22 percent never live independently. These figures have not changed in the past 15 years, and qualify hip fractures as a major health care issue in Canada.”

Providers with Low Rehospitalization Rates Tend to Stay That Way

In a study published in Health Services Research, Momotazur Rahman, Ph.D., and former NIC presenter David Grabowski, Ph.D., along with others, studied the predictability of rehospitalization for a skilled nursing patient based on the skilled nursing property’s previous rehospitalization rate. The researchers concluded that patients who receive treatment in a skilled nursing property that has a historically low rehospitalization rate are less likely to be readmitted to the hospital. The findings were so enough, the researchers concluded that this trend is causal, not merely a correlation. For those operators with high rehospitalization rates, the findings of this study suggest that they consider how those rates could be improved.

Takeaways for Skilled Nursing Operators

Skilled nursing operators can derive valuable information from these three studies. First, as the two hip fracture studies reported on by HealthDay imply, it’s critical for operators to be aware of the hospitals in their referral regions and their performance levels. For example, when negotiating rates and inclusion in networks with Medicare Advantage plans, demonstrating a robust understanding of a hospital partner’s quality can help operators communicate the value they bring to risk-bearing payors.

Additionally, as Sheehan’s study illustrates, the hip fracture cohort is at high risk for poor outcomes. Again, operators can capitalize on this data to improve outcomes by making care plan decisions that reflect the known risk their patients face. Assisted living providers may be able to use these studies to make the case that they provide an environment that helps prevent high-risk seniors from falls.

Data will be essential to demonstrate value for providers with a proven track record of reducing rehospitalizations. The rehospitalization study indicates that potential partners and even consumers could see the value in a provider whose rehospitalization rate is low.

Skilled nursing operators may find themselves increasingly looking to data as demands from consumers, regulators, partners, and payors grow. Having knowledge of their own performance, as well as the industry’s and their partners’, can help operators get an edge over less data-savvy competitors.

Third-Quarter 2016 Skilled Nursing Data Report Coming Soon

The complimentary NIC Skilled Nursing Data Report with data as of the third-quarter 2016 will be released later this month. If you’ve downloaded a previous version of the report, you’ll receive a notification once it’s available.

In the meantime, check out the second-quarter data:

Download 2Q 2016  Skilled Nursing Data Report

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