Madden, Kathleen A.

Introduction The Centers for Medicare & Medicaid skilled nursing facility (SNF) 3-day waiver permits patients attributed to an Accountable Care Organization (ACO) to be admitted to an SNF or transitional care unit from an emergency department, outpatient setting, inpatient stay (<3 days), or observational status without Medicare’s requisite 3-day inpatient stay. Methods Our institution’s ACO implemented the waiver program in 2023. We report our experience with implementing the waiver and describe benefits and barriers, as well as interventions developed, outcomes achieved, and opportunities presented for patients and health care facilities. Results Through a streamlined process, patients can more readily access essential care, and health care facilities benefit from enhanced efficiency. Furthermore, the ACO can more effectively manage health care utilization and cost. Although the program offers benefits to patients, their families, and health care facilities, implementing and maintaining the program has challenges, with barriers including underdeveloped workflows, gaps in staff education and communication, difficulties in patient identification, and challenges with specific facility requirements. Conclusions The SNF 3-day rule waiver has been valuable in enhancing patient care and optimizing health care delivery within our ACO. Ongoing efforts to refine processes and address challenges will further improve the program’s effectiveness and sustainability.

Objective: The purpose of this study was to implement a 2-phase approach to rapidly increase the number of annual wellness visits (AWVs) and build a sustainable model at 3 study units (Mayo Clinic in Rochester, Minnesota, and clinics in 2 regions of Mayo Clinic Health System), which collectively serve approximately 80 000 patients who qualify for an AWV annually. Methods: In the rapid improvement phase, beginning in July 2022, goals at the facilities were reoriented to prioritize AWVs, educate staff on existing AWV resources, and create low-effort workflows so that AWVs could be incorporated into existing patient appointments. Staff at all 3 study units worked independently and iterated quickly. In the second phase, all study units collaborated to design and implement a best-practice solution while they leveraged the engagement and lessons learned from the first phase and invested in additional system elements and change management to codify long-term success. Results: The number of AWVs completed monthly increased in each study unit. In the rapid improvement phase, the number of AWVs increased but then plateaued (or decreased at some study units). In April 2023, the final scheduled outreach automation and visit tools were implemented, and the number of AWVs was sustained or increased, while outreach and scheduling times were decreased. The number of completed AWVs increased from 1148 across all study units in the first 6 months of 2022 to 14 061 during the first 6 months of 2023. Conclusions: The lessons learned from this project can be applied to other health systems that want to provide more patients with AWVs while improving operational efficiency. The keys are to have a clear vision of a successful outcome, engage all stakeholders, and iterate quickly to find what works best for the organization.