The continuum of care: Healthcare reform's effect

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Hudson Garrett
Hudson Garrett
Our healthcare system has recently seen, and will continue to see, significant changes.  There are particular implications for long-term care facilities but, overall, healthcare costs are increasing, the payment model is changing and new provider structures are developing. The Affordable Care Act and healthcare reform legislations were designed to achieve the “Triple Aim.” 

This includes improving the healthcare of populations served, reducing the per capita cost of care, and improvements in patient experience (i.e. patient satisfaction).[1] Pressure is increasing for the industry to move from “volume-to-value” and this is influencing the way healthcare systems operate, as they must adapt and find ways to develop the infrastructure to support such change.

Due to the high dependence on Medicare and Medicaid reimbursement, long-term care facilities and assisted living communities will be greatly affected by these ongoing changes. How they contribute to the continuum of care will be important in light of patients being shifted from the traditional in-patient acute care and Long-Term Acute Care Hospital to the Long-Term Care Facility. The mitigation of healthcare-associated infections (HAIs) in this high-risk population should also be priority.

Long-term care is an in-patient environment and is being included under many of the recently released mandates affecting in-patient hospitals. The exact future of healthcare reform is uncertain, but deadlines are approaching over the next few years. The Centers for Medicare & Medicaid Services annually updates the list of non-reimbursed conditions, which now includes healthcare-associated infections and other “never events.” Previously, the infection prevention department was seen as a cost center, but in this new era of healthcare reform, infection prevention is very much a cost mitigation technique for facilities.

In addition, the Department of Health and Human Services recently released a draft of the healthcare-associated infection action plan, which has a specific module for long-term care. It is expected that this new action plan will result in reimbursement restrictions around healthcare-associated infections in long-term care in late 2014.[2]

Increasing pressure will also be put on the long-term care facility to work with acute care facilities as the patients of these institutions are not “patients,” but rather lifelong residents. This creates a unique challenge that does not exist in the traditional acute care model and places the burden directly on the facility. It must coordinate the care of the resident across all spectrums of healthcare, including acute care receiving facilities. Given that many long-term care facilities are unable to provide intravenous antibiotics and other advanced medical treatments, collaboration between the facility and the acute care receiving hospital is critical. The infection preventionist and/or nurse should communicate to the receiving facility any communicable diseases as well as infection prevention concerns that might be relevant to the patient's care.

All healthcare facilities should strive to achieve the Triple Aim together. The Triple Aim was identified by the Institute for Healthcare Improvement (IHI) and is a well evidenced framework that optimizes health system performance across the continuum of care. These efforts are designed to transform the manner in which healthcare is delivered and provide a higher level of quality of care for the patient over a number of different healthcare platforms. Visit the IHI's website for more information.

J. Hudson Garrett Jr, PhD, MSN, MPN, FNP, CSRN, VA-BC, DON-CLTC, C-NAC, is the vice president of clinical affairs at PDI.


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