Table 1.

Description of Innovations in Models of Care and Their Impact on SNF Sustainability

Innovative Models of Care		Description	Impact on SNF Sustainability
The Patient Protection and Affordable Care Act (ACA) of 2010 (P.L. 111–148) 115			• Encourages collaboration across the continuum of care • Innovations in care to minimize cost have the potential to attract more business (i.e., patients and Medicare Advantage contracts). • If SNFs meet set goals for cost-containment and coordination of care, they share in the cost-savings. If set goals are not met, they can also share in the net loss.
	The Centers for Medicare and Medicaid Services (CMS) Innovation Center (Section 3021)
	Bundled Payments for Care Improvement (BPCI) 52,116	• Medicare reimburses providers for individual episodes of care using separate payment systems, which leads to fragmented payments and poor coordination of care.117 • Seeks to determine if the use of bundled payments within a single episode of care (e.g., from the hospital to the SNF) leads to better coordination of care and improved outcomes.116,117
	The Comprehensive Care for Joint Replacement Model (CJR)51,118	• Focuses specifically on bundling payments for episodes of care following lower-extremity joint replacement to potentially reduce the high volume of health care utilization and spending in this population.119
	Accountable Care Organizations (ACOs) (Section 3022) 113,120
	• Established under the ACA as formal arrangements between providers (e.g., doctors, hospitals, and SNFs) to help incentivize providers to coordinate care through collective accountability.121 • Hospitals and SNFs can also form informal to coordinate services, referrals, and financial savings.
Protecting Access to Medicare Act (PAMA) of 2014 (P.L. 113–93) 49		• In an effort to hold SNFs accountable for the care they provide and the subsequent link to patient outcomes, PAMA amended the Social Security Act to penalize SNFs for potentially avoidable rehospitalizations within 30 days of SNF admission beginning in October, 2018.49 • Under the new provisions of PAMA, the Department of Health and Human Services estimates that Medicare could potentially save $2.2 billion by 2027.122	• SNFs are incentivized to improve care for patients to prevent 30-day readmissions and future monetary penalties. • Has the potential to improve quality of care for patients and thus SNFs’ competitiveness in the post-acute marketplace
Improving Medicare Post-Acute Transformation Act (IMPACT) of 2014 (P.L. 113–185) 123		• Legislated to require all SNFs participate in a SNF Quality Reporting Program (SNF QRP) beginning in 2018. • The SNF QRP will use data from the Medicare fee-for-service claims dataset to determine the percentage of short-term patients who are discharged to the community, the number of potentially avoidable rehospitalizations within 30-days post-discharge to a SNF, and Medicare spending per beneficiary with SNF care.124	• The longitudinal data collected through the SNF QRP will allow SNFs to see their trends in quality measures and to use that data to better coordinate care and thus, improve outcomes for patients. • Has the potential to improve SNFs’ competitiveness in the post-acute marketplace