By Win Whitcomb

Managing Episodic Length of Stay (ELOS) in skilled nursing facilities (SNFs) is an important strategy to reduce unnecessary costs and improve outcomes during a patient’s episode of care. It is well established that SNF length of stay varies widely between geographic regions and by payer type (fee for service vs. managed Medicare, for example). This variability is perpetuated by a lack of accessible, standardized information about expectations, performance, and outcomes. The SNF Episodic Length of Stay (ELOS) Guidelines seek to address this issue by offering clinical recommendations and data-driven targets for managing SNF length of stay at the bundle level.

The SNF Episodic Length of Stay Guidelines, first introduced in 2014, support the Bundled Payments for Care Improvement (BPCI) initiative’s dual goals of improving patient outcomes and reducing unnecessary costs. The Guidelines support optimal SNF length of stay, form a basis for accountability, and assist the ongoing evaluation of Remedy’s SNF Performance Network by helping to identify high performing SNFs. Episodic length of stay, which refers to the total number of SNF days during a patient’s 90-day episode, was chosen over alternative metrics like initial length of stay (which only includes a patient’s first SNF stay during an episode but omits subsequent SNF stays) in order to encourage SNFs to decrease avoidable readmissions after discharge by facilitating safe transitions out of the facility and avoiding unnecessary acute care transfers during the episode.

The updated 2017 SNF ELOS Guidelines offer expanded discharge planning guidance and an updated Target ELOS for each of the 48 CMS BPCI bundles, which was recalculated from the most recent Medicare Limited Data Set. The Target ELOS is a range of episodic length of stay for a given bundle that frames the time period during which the patient will likely meet functional and clinical goals, allowing them to be safely discharged to the next level of care. The Target ELOS ranges are data-driven, aspirational, and attainable. The discharge planning for home section provides discharge recommendations for Nursing, Rehabilitation/Functional, and Social Work to implement on admission, during the patient’s SNF stay, and before discharge.

The SNF ELOS Guidelines can be used by BPCI Episode Initiators (EIs), such as Hospitals, Physician Groups, Model 3 Skilled Nursing Facilities, and by organizations partnering with Episode Initiators, such as downstream SNFs and Home Health Agencies, to align expectations for length of stay. For EIs, the Target ELOS and recommendations for discharge home facilitate dialogue with the SNF regarding BPCI program performance. For organizations partnering with EIs, the SNF ELOS Guidelines serve numerous purposes including:

• Aligning expectations for SNF length of stay to anticipate the transition home
• Providing target length of stay ranges for SNFs in Remedy’s performance network
• Setting expectations for performance for SNFs seeking to enter such networks
• Allowing the healthcare team to manage patients’ and caregivers’ expectations for length of stay at a SNF

Remedy provides support to facilitate the collaboration between various stakeholders to optimally implement these guidelines.

All in all, the SNF ELOS Guidelines support an optimal SNF length of stay and provide numerous benefits to facilities and agencies that care for a patient during an episode of care.

If you would like additional information or have any further questions regarding the 2017 SNF Episodic Length of Stay Guidelines, please contact the Transitional Care Institute at [email protected].