Steven Littlehale, EVP and Chief Clinical Officer, PointRight Inc.
An admired colleague once said, “If you want me to be proficient in caring for a specific type of patient, I can … just give me a lot of them.”
Practice doesn't necessarily make perfect, but it should improve your odds. This notion is compatible with the perception that to be successful in most markets, skilled nursing facilities need to specialize in areas that align with market needs. But how are specialization and volume reflected in the very outcomes that often define success?
To begin to understand this, we identified SNFs (n = 4,041) that specialized in dementia care (67% of residents) and compared their success outcomes to those SNFs (n = 3,995) that cared for residents with dementia but in much smaller volume (21%). Rehospitalization rates were lower, suggesting that clinicians were more skilled at properly identifying and assessing acute changes — in contrast to their less-practiced counterparts.
However, length of stay was higher, which suggests rehab of dementia patients takes more time. It's an interesting finding when considering bearing risk or simply explaining outcomes.
“Practice makes perfect” was also apparent throughout the Five-Star Quality Rating System. Overall, and in the survey domain, facilities specializing in dementia had superior outcomes.
One could argue that dementia care, as opposed to other specialties, is better understood within our clinical and regulatory system. But could it be that a commitment to a specific cohort makes for a better organization?
Interestingly, the high-volume SNFs performed better on specific “dementia F-tags” (F-tags 309, 329, 222). Even with more opportunity to “get it wrong,” these high-volume facilities got it right.
Admittedly, this analysis raises more questions than provides answers, and we look forward to continuing the exploration. Until then, practice does seem to lead toward proficiency — and that is a prerequisite for success in payment models rooted in outcomes, efficiency and satisfaction.