The LTC continuum may include services ranging from adult day care, senior centers, respite care, skilled nursing facilities (SNF), rehabilitation programs, home health care, assisted living, and nursing homes. LTC services are typically needed when a person has an ongoing, long-term disability as indicated by increases in physical and cognitive impairments or loss of function as measured by impairments in activities of daily living.
Skilled care's role in the continuum
Skilled nursing providers face pressure to break into hospitals’ top-tier referral groups — the increasingly select few deemed fit to manage acute care operators’ patient populations across the continuum.
The size of hospitals’ preferred SNF networks varies considerably, depending on location and patient volume, but many are shrinking and the savviest operators are the ones with a pulse on their particular market landscape.
In general, it’s best not to look at a SNF network as an unchanging roster of providers from which hospitals can choose. The decision on where to send patients should be made for a variety of reasons, including geographic location and patient preference.
Care coordinators should focus on building relationships with key SNF providers in their inner circle. There’s another reason hospitals shouldn’t view their SNF partnerships as static: specialization. As skilled nursing operators look to set themselves apart from the competition in new payment models, some providers have turned to ventilators, cardiac recovery programs, and other specialty services that not all SNFs provide.
Hospitals should always have “backup” relationships with providers that can offer certain services that others can’t.
If a hospital really wants a strong post-acute care program, it needs to consider its specific needs in the context of the SNFs in the market.
Population size matters
Building a SNF network has less to do with a specific number of providers and more to do with demonstrated quality. In a payment system where hospitals are increasingly asked to share risk with skilled nursing providers and other downstream care settings, acute care providers must build relationships with reliable SNFs that can prevent readmissions and provide solid clinical outcomes.
Many hospital networks have gotten more serious about developing a stable of trusted partners. As acute care providers are forced to take on more and more risk — especially as their reimbursements depend on how well SNFs can keep residents out of the hospital — they’re depending more and more on network collaboration.