MACIPA invited by CMS to present on the Implementation of the SNF 3 Day Rule Waiver

POSTED ON September 13, 2018 BY MACIPA

MACIPA is one of a few ACOs nationwide approved to utilize Medicare’s SNF 3 day rule waiver. Under the waiver, ACO beneficiaries can be admitted to a skilled nursing facility (SNF) prior to completing a 3 day hospital stay if they meet certain clinical requirements. Since January 2017, 114 of MACIPA’s beneficiaries have utilized the 3 day waiver. Patients and their families are made aware of the option when it is recommended by their Care Manager and physician. Positive outcomes include earlier access to meaningful skilled therapy services and being able to return home sooner. Only 61 MSSP ACOs out of 562 in the US have been approved to use this waiver.

Diane Shapiro, COO, and Bob Hill, Dir. Care Mgmt, presented at CMS’ ACO Learning System, stating that strong coordination and communication among MACIPA, SNFs and Mount Auburn Hospital (MAH), along with a lengthy history in population health/quality management, strong physician leadership, and a methodical implementation were reasons for success. MACIPA developed a Checklist for the 18 MAH care managers to determine patient clinical appropriateness, and a Talking Points Summary to use when explaining the waiver program to patients and caregivers. Phyllis Zammuto, RN, MACIPA Care Manager, reviews all requests. Physicians, SNFs, and the hospital Care Managers are instructed to contact Phyllis if they have a patient who could quality. MACIPA chose the SNFs based on strong pre-existing relationships, a willingness to streamline the admitting process and to collaborate on a care plan. The SNF’s lengths of stay and bounce back rates, philosophy of care, and reputations for quality were also important considerations. Maintaining frequent communication with the participating SNFs has been critical to the program’s success. For more information, please contact Phyllis Zammuto at pzammuto@macipa.com.

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