Interoperability is more important than ever
Post-acute care consolidation has become the new normal, with more and more health systems acquiring or establishing partnerships with SNFs and LTACHs. This growing trend is due to many converging factors, especially value-based care's new and emerging payment models and hospitals looking to create new revenue streams while providing patients with greater continuity of care across the post-acute care spectrum.
As with any type of change, there are upsides and downsides to consider:
On the positive side, consolidation has the potential to break down siloes to better align healthcare objectives, reduce conflicts, and improve acute to post-acute care coordination and transitions of care.
On the negative side, there's always a risk that revenue considerations—especially in light of newer reimbursement models such as bundled payments—could drive care decisions, resulting in issues such as patients being discharged too early.
In addition, health systems don't have expertise in post-acute care operations, and applying acute care principles to this environment could have dire consequences. Take, for example, IT system capabilities.
HIS are not built for the post-acute care space
When health system administrators that are integrating post-acute care services and facilities begin looking at technology solutions, the idea of adopting the hospital information system for both acute and post-acute care may seem at first glance like a tempting approach. However, enterprise HIS lack essential functionality needed for post-acute care and therefore cannot meet the unique needs of SNFs and LTACHs.
Both the acute care and post-acute care environments are highly regulated with specific requirements for coverage and reimbursements. While hospital administrators or doctors may say that a note is a note, an assessment is an assessment, or a chart is a chart, they aren't acknowledging the uniqueness of the post-acute care environment—for example, how charts get audited is a completely different process, which means the information needs to be documented differently. Other nuanced functions, such as putting a patient on a bed hold so that it can be billed, can't be done through an acute care enterprise system.
Patient volumes and documentation needs are very different, which means that HIS can be clunky and inefficient when it comes to entering critical post-acute care patient data. While bedside hospital nurses may have two to six patients at a time to care for (depending on the level of care), nurses in the SNF environment may have up to 30. When patient weights need to be documented, for example—a critical function to monitor for fluctuations that could indicate a serious health issue, such as congestive heart failure—SNF nurses need a screen where those 30 weights can efficiently be entered, rather than entering them one at a time as an acute care nurse would. In addition, when it comes to minimum data sets required by the Centers for Medicare & Medicaid Services for reimbursement, post-acute care nurses need to track details such as meal acceptance and activities of daily living, which aren't even on the acute care radar—and therefore not integrated into their HIS.
HIS are designed for shorter, finite inpatient assessment. A software platform designed specifically for a post-acute care setting collects patient data and analyzes trends that can sometimes occur gradually (e.g., dementia) for longitudinal analyses and better diagnoses, which lead to better interventions.
True interoperability, even between entities within an acute care setting still isn't occurring. While theoretically having all entities within a health system on the same HIS, sharing EMR data, should result in better continuity of care, it's simply not yet a reality. If doctors' offices and hospitals within the same health system still aren't seamlessly able to share information such as lab results, physician orders and medication allergies in near real time, the same applies for sharing of information between acute and post-acute care settings within the same health system. It's not worth giving up the increased functionality of a post-acute-care-specific software platform to move SNFs to a HIS if a patient's allergy information still won't be available until two days after admission. Instead, the focus needs to be on maintaining program specific systems for acute and post-acute environments and creating interoperability so that patient information can easily be shared for optimal continuity of care.
With new payment models such as accountable care organizations and bundled payments focused on high-quality, cost-effective care across the acute to post-acute care continuum, the paradigm is shifting. As a result, the technology also needs to shift to keep pace--but in a way that recognizes the unique needs of the post-acute care environment vs the acute care environment.
The solution lies with working towards interoperability between acute and post-acute IT systems, instead of the blanket adoption of a HIS designed specifically for the hospital setting. Achieving true interoperability will require cooperation and collaboration across all spectrums of care—for the good of the patient/resident.
If your SNF or LTACH is currently undergoing a consolidation (or may be in the future), it's important to make the case for the specific tools and technology you need to meet the needs of your residents and clinical staff. Consider it a step towards achieving value in today's emerging value-based care environment.
Carrie O'Connell, RN, is executive vice president of clinical informatics for HCS Inc.