HealthOctober 09, 2017

The post-acute conundrum

The earth is shifting under the feet of the people who operate skilled-nursing facilities. The market is moving away from the traditional nursing home, and patient and family preferences are making themselves felt in reduced demand for long-term care. Patient stays are shorter and treatments are more intensive. Some hospitals are closing their skilled-nursing units for lack of demand.

At the same time the federal government is adding on a new layer of regulations and mandates. And for the first time, reimbursements from Medicare and Medicaid are now being pegged to quality outcomes, patient satisfaction, and readmissions to the hospital. Starting in 2018 CMS is imposing a 2% penalty for excess readmissions.

Medicare patients have the right to go to the post-acute provider of their choice, but there are signs this policy may be modified to allow hospitals to steer them toward particular providers. Already, for Medicare’s joint replacement bundled-payment program, hospital discharge planners may recommend post-acute providers. The staff of the Medicare Payment Advisory Commission (MedPAC) are recommending that this be expanded to all Medicare hospital discharges. Discharge planners would have to consider quality of care in the post-acute facilities they recommend, and hospitals would have to provide quality data to beneficiaries seeking post-acute care. In addition, the Hospital Readmissions Reduction Program would be expanded to more conditions. Value-based purchasing would be established for inpatient rehab facilities and long-term care.

According to a recent survey of health care CEOs by the investment firm Lazard, value-based care is seen as having the most transformative impact on the health care industry, ahead of all other challenges. By 2020 the majority of health care payments in the U.S. will be value-based or risk-sharing, U.S. executives believe. Accordingly, it seems that all participants in the continuum of care are eventually going to be drafted into this new payment methodology. Hospitals, large physician practices, and accountable care organizations are already in the midst of this transition. Skilled-nursing and rehabilitation facilities are right on the threshold.

The operational transformation

To navigate this challenging environment, SNF operators need to think about how they will adapt while staying within the resource constraints that obtain in the industry. They need to figure out ways to get more productivity and consistent results from their labor force and nursing staff. They need to extend the reach of their staff to ensure that patients are ready to engage in completing their rehabilitation and return to activities of daily living at home.

As part of value-based care, SNF’s need to engage and activate patients and their caregivers in their care, so they are participating in everything they need to do to regain full function and stay healthy.

Technology offers a solution

Applying technology to the problem offers a roadmap to possible success. Interactive solutions like those offered by Emmi use technology to scale up human effort dramatically. These digital and telephone programs not only educate patients and families about the care they are about to receive, they encourage them to become active participants in their own recovery. Then they maintain the connection to patients after discharge. These have not been priorities in the post-acute space, historically. Indeed, some SNFs are still using outdated photocopies and printed materials to communicate with patients.

But in the transition to value-based reimbursement, quality of care and engagement with patients will become more important and recognized. The investments in these technologies will pay off in better outcomes, better quality, and more successful discharge to the community, which in turn will build better referral relationships with hospitals and discharge planners. SNFs that decline to commit to these advanced solutions may find that it hinders their ability to deliver the high-quality care and above-average outcomes that are required to become a premier choice. In a perfect world, a SNF would have a dedicated coach to guide people who are discharged to the community. Unfortunately, that is not always a cost-effective solution.

An integrated solution is required

What post-acute providers need is a fully integrated solution that connects patients to caregivers through any media that patients are comfortable with. The information delivered must be geared to the patient’s level of health literacy. It should also be able to track the patient’s progress with interactive information sharing. That is, the patient should be able to give responses that allow caregivers to notice and follow up if the patient starts to fall off the path to recovery.


Engage every patient in their journey

Easy-to-use interactive programs, featuring conversational language and relatable examples, help you foster connections and extend your team’s reach beyond healthcare settings.