I can't get my head around the CMS Plan for healthcare reform and how it will change my world.

There are nearly 20,000 pages of regulations in the ACA. We’re here to help you understand the essentials for success.

It starts with an Operational Analysis…

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Tri-ple Aim

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1The Institute for Healthcare Improvement has developed a framework for optimizing health system performance. It is commonly known as “Triple Aim”:

Customer Satisfaction


Functional Improvement


At Consonus, we aid our customers in achieving the triple aim through our analytical reporting tools for Customer Satisfaction, Readmissions, Functional Improvement, and Quality. Monitoring a customer’s progress in these key areas is only half the battle. Consonus offers consulting guidance in each category to help our customers outperform the competition and thrive.

what are the future payer sources & the payment models?

Payer Sources

  • Institutional Special Needs Program

    A Medicare Advantage product available to populations served by SNF, ALF, and HH for at least 90 days.

  • Dual Eligible Special Needs Plans

    A type of Medicare Advantage plan that enrolls only individuals dually eligible for Medicare and Medicaid.

  • Accountable Care Organization

    A payment and care delivery model that connects provider reimbursements to quality metrics and reduced the total cost of care for patients.

  • Dual Eligible Special Needs Plans

    A private company that contracts with Medicare to manage Part A and Part B benefits.

  • Dual Eligible Special Needs Plans

    An entity that may or may not take risk in the care of Medicare patients by partnering with acute and/or post acute providers for selected diagnosis groups.

  • Patient Driven Payment Model

    Effective October 1, 2019 is a reimbursement change for Medicare patients, focusing on the patient's characteristics. It will affect every department within a facility and is the biggest reimbursement change in over 20 years.

Payment Models

There will be different Payment Models

Traditional Fee for Service Model

Pre Admission Services
Part a Hospital
Part B Inpatient
Post Acute Costs

Bundle Payment Model

A single lump payment, usually by diagnosis, paid to multiple providers within a continuum

Pre Admission Services
Part a Hospital
Part B Inpatient
Post Acute Costs

Episodic Payment Model

Similar to the hospital DRG model. A lump sum payment paid to a single provider (SNF & Home Health) for an episode of care.

Patient Driven Payment Model

PDPM more accurately accounts for resident comorbidities and patient-specific care needs while reducing the emphasis of therapy minutes. PDPM is also designed to decrease administrative complexities through an overhaul of required MDS schedules.




Discover how your organization will fare under this new model by viewing the data analysis below.

How does the value based purchasing market work?


In order to fund the incentive payment pool,

When does this all happen?

Implementation happens in stages

  • FY 2016

    Resolved Denials Timeline
    • The Secretary of Health and Human Services (HHS) must specify a SNF all-cause, all-condition readmission measure by October 1, 2015.
  • FY 2017

    Resolved Denials Timeline
    • The Secretary must then specify an all-condition, risk-adjusted potentially preventable hospital readmission rate by October 1, 2016.
  • FY 2018

    Resolved Denials Timeline
    • Public reporting of readmission measures appear on Nursing Home Compare.
  • FY 2019

    Resolved Denials Timeline
    • SNFs’ Medicare payment rates will be based on (in part) their performance scores beginning on October 1, 2018.

Healthcare reform is changing the game, understanding these changes will be critical to succeeding in the future.