Jeff Terkowitz
Jeff Terkowitz

For skilled nursing facilities it’s a struggle to stay ahead of the Medicare initiatives and market forces that are causing hospitals and health systems to narrow their post-acute care networks. With so many competing priorities — the alphabet soup of BPCI, ACOs, VBP, etc. — it can be hard to stay ahead of all the changes.

The good news is that it’s not too late for SNFs to solidify their position within hospital- and health system-driven networks. An Avalere analysis using the Vantage Care Positioning System™ found that between 2009 and 2012 – the most recent year for which CMS has released comprehensive Medicare data – there was an increase in the average number of SNFs that received volume from hospitals. However, that trend may be slowing; the .3% increase in average number of SNFs to which hospitals discharged patients in 2012 comes after increases of .7% and .9% per year from 2009-2011.

  • In 2009, short-term acute care hospitals discharged patients who were admitted on average to just over 37 different SNFs following the hospital stay
  • In 2010 and 2011, that number grew, with hospital patients going to just under 38 and just under 39 SNFs, respectively
  • In 2012, that number reached 39.14, a slight increase from 2011

So, hospitals are still sending patients to many different SNFs, indicating that networks may not be well established, but it also raises another question — even though the total number of SNFs is still going up, are we seeing higher concentration of patient volume at a smaller number of facilities?  Between 2009 and 2012, there was a slight increase in concentration — the average hospital went from having just over nine SNF partners who received 10 or more patients to having 9.54 partners receiving that higher volume. 

What this finding suggests is that the hospital and health system response to changing incentives in the Medicare program has been slower than we might have expected. As a result, there are still opportunities for SNFs and other post-acute providers to get in the door as these networks form. The opportunity varies within markets; in some areas, hospitals and health systems have established networks that may be difficult to penetrate.  However, in most markets it’s likely that there are still opportunities to partner with hospitals and join a network. 

As a SNF, you should not delay though; the window of opportunity is closing, and there are many examples of hospitals moving towards tighter, more coordinated post-acute care networks. In this environment, SNFs need to continuously refine and improve their value proposition as network partners.

Jeff Terkowitz, senior manager, oversees the design, maintenance, and ongoing enhancement of Avalere‘s Vantage Care Positioning System™ (CPS).