Eighty-one percent of all Florida Hospitals were recently penalized for higher post-acute Medicare spending during 2013, with 2014 projections looking just as dire. For the next few years, CMS is holding hospitals accountable for all Medicare dollars spent outside its walls by post-acute providers.The largest post-acute spending category is Skilled Nursing. SNF spending is accountable for Florida’s extremely high Medicare Spending Per Beneficiary Measures (MSPB). Florida is second only to New Jersey for having the most financial inefficiency. But there may be a light at the end of the tunnel.
The Community Integration Model (CIM), designed by a social worker, is a disruptive innovation to the current Continuum of Care. The CIM was designed to reduce PostâAcute Medicare spending for hospitals; it directly affects top-and-bottom line revenues by having discharge planners first “rule out” nonâMedicareâfunded discharge options (like assisted living) before Skilled Nursing, regardless of patient “eligibility” for the SNF benefit.
Ideal candidates for the CIM are patients who have used their initial “free” 20 days of SNF benefits. Rather than paying the 20% SNF copay, families are choosing assisted living options since, in most cases, it is more cost-effective.
To ensure a safe discharge, the CIM leverages a firstâofâitsâkind predictive software whose algorithms match individual patients’ unique diagnoses and care needs with calculated variables of area Assisted Living providers. The software evaluates previous success records and quality outcomes for the patient. Medicare Home Health Agencies are utilized to service the skilled care needs of the patient at a significant savings. The CIM is currently being piloted in Florida by the Lee Memorial Hospital System in Fort Myers. CIM founders are looking for other hospitals across the state to pilot the free model.