As the administrator of a large, 240-bed, privately held,

Last updated: 7/8/2022

As the administrator of a large, 240-bed, privately held, nonprofit nursing and rehab care facility with a designated dementia unit, you have been approached by an area hospital, from which you receive most of your skilled nursing patient referrals, about joining its accountable care organization. Communication between your director of admissions and the hospital discharge coordinator for incoming Medicare skilled nursing facility (SNF) residents has been difficult at times, especially in terms of establishing immediate SNF care such as medications and therapy plans; however, your facility has benefited from the partnership and has confidence in the hospital overall. In order to participate in the ACO, you will have to agree to bundled payments for some episodes of care for which you provide rehab services, and you will have to develop on-site home health services that are put in place immediately after a patient's discharge from the SNF to home. You will also achieve some reimbursement incentives by joining the network for assisting the ACO in meeting quality benchmarks, but you may incur reimbursement losses if you are unable to meet these benchmarks. In the past three years your rehospitalization rate average is on par with the state average, but slightly below direct competitor's in your immediate area. In order to achieve desired outcomes, rehospitalization rates would have to drop 4.5% in the next year and 10% over the next five years. Respond in this discussion post to one Case Study Question: 1. Make a case to bring forth to the board of directors of your organization for joining the ACO. In this argument, describe the opportunities associated with joining the ACO while considering what it would take with an emphasis on care coordination, care transitions and community-based LTSS. 2. Assume that your organization has decided to join the organization. What will you do to begin lowering hospitalization rates to meet ACO reimbursement goals for best practices?