Focus on physician groups, managed care to prepare for the future, say long-term care experts

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Skilled nursing providers should build partnerships with physician groups and hospitals but need to make sure to stay abreast of legal and regulatory frameworks, according to experts who spoke at McKnight's Fall Online Expo.

Hospitals are commonly seen as the most important players in accountable care organizations and other emerging healthcare delivery models, but large physician groups are actually the driving force behind the move to coordinated care, said Dale Zaletel, a senior operations consultant and post-acute development strategist.

Doctors have moved away from close relationships with hospitals to form large physician practice groups that offer many services once exclusive to hospitals, said Zaletel, who has been a leader in both the hospital and long-term care sectors. In some areas, the physician group has contracted with a managed care company and actively tries to avoid sending patients to the hospital, cutting into hospitals' revenue streams. Even though hospitals have in some cases acquired or partnered with physician groups, post-acute providers should not see hospitals as necessarily the most powerful players in a coordinated care environment, Zaletel advised.

“We will have to work with hospitals, but physicians will ultimately drive the business into your beds,” he said. “Identify who the key physician groups are and get them involved in your center's operation.”

SNF leaders should seek out the office or field agent of the managed care companies associated with local physician groups, Zaletel said. He advised presenting a case for how the post-acute provider can offer a transitional managed care model involving doctors, nurse practitioners, transitional care nurses and other important players.

While SNFs should indeed establish relationships to become a preferred provider within their local network, they also must avoid legal pitfalls, said Matthew J. Murer, chairman of the National Health Care Group at Chicago law firm Polsinelli.

Signing a preferred provider agreement is generally a positive step, but anti-kickback and antitrust issues must be considered, and patients must have freedom in choosing where to receive post-acute care, Murer said. He noted there are ways to form partnerships that do not involve formal preferred provider contracts.

Murer concurred with Zaletel that Medicaid managed care is looming as a fee-for-service replacement, and noted that post-acute providers should prepare to negotiate reimbursement rates rather than settle for what the government dictates. SNFs would be wise to hire people with experience in negotiating with managed care companies, he advised. 

The Expo also featured a session on upcoming Minimum Data Set changes. Providers must understand and implement May's substantial MDS changes to be in good shape for October's updates, said Leah Klusch, RN, BSN, executive director of The Alliance Training Center.

The upcoming changes include coding variations for feeding, identifying therapy co-treatment and documenting therapy minutes. To ensure a seamless transition, Klusch recommended that providers start planning training sessions now. Providers should also contact their software vendors to ensure the electronic records remain current.

“The changes in October are going to have a significant impact on you,” Klusch said. “But they aren't going to be very difficult on you. This is isn't rocket science, but you have to get it right.”

Archived versions of the Fall Online Expo webcasts can be viewed by clicking here.  Click on the “Agenda” button to see the three presentations.