Network Success Story
In 2018, OneCare elected to offer the 3-Day Skilled Nursing Facility (SNF) Rule Waiver under its Medicare program. The SNF Waiver allows a Medicare beneficiary, who is attributed to OneCare, to be admitted to a participating SNF without the traditional fee-for-service Medicare qualifying 3-day hospital stay. Under the SNF Waiver, patients can be admitted to a SNF from short-inpatient, observation, emergency department (ED), provider office, or patient’s home after a medical exam confirming a skilled nursing need, avoiding unnecessary inpatient stays and allowing patients to access their skilled nursing benefits sooner.
Focus / Spotlight
Clinically appropriate access to SNF care for patients exhibiting a skilled nursing need including physical therapy, occupational therapy and speech therapy to return to prior level of functioning.
Reduces avoidable and costly ED and hospital stays with admissions from provider office or home.
Promotes patient-centered care and shared decisionmaking.
Outreach and education to Medicare program participating hospitals and eligible SNFs
Development and roll-out of Operations Manual to guide implementation and utilization
Training provided to providers and SNFs on SNF Waiver program, including building workflows for patient admissions to SNFs and using the OneCare Secure Portal
Spotlight on the Middlebury Health Service Area SNF Waiver Pilot
In spring 2018, Porter Medical Center and Helen Porter Rehabilitation and Nursing, part of the UVM Health Network, were chosen as a pilot site for implementation of the SNF Waiver. OneCare Clinical Consultants worked with staff at both facilities to implement the SNF Waiver and Helen Porter admitted its first patient under the SNF waiver in May 2018. The following implementation steps were taken to ensure a successful SNF Waiver program roll-out:
Identification of roles and responsibilities of both hospital/medical staff and SNF staff
Patient attribution identification process established at Porter Medical Center, with ACO attribution patient identifier button added to hospital EHR system
Discussions and education on the SNF Waiver incorporated into Transitions of Care Committee meeting between hospital and SNF
Creation of patient admission work flow from ED to SNF under the SNF Waiver. This is used as an example during ongoing OneCare SNF Waiver trainings
Outcomes: Since the initial roll-out of the program in the Middlebury HSA, 24 patients have been successfully discharged from Helen Porter under the SNF Waiver in 2018; 7 from Observation, 15 from Short-Inpatient (< 3 days) and 2 from the patients home.