The statistics are troubling. Each year, according to the Centers for Medicare & Medicaid Services, in many states, about 25% of patients admitted to a skilled nursing facility from a hospital are readmitted within 30 days. At some SNFs, readmissions rates are as high as 40%.
While a variety of factors influence readmissions, as an industry there is much more we can do. In fact, we know we can do better: At some institutions, readmissions are down to 4%.
What is the difference between high and low-performing SNFs and post-acute care facilities? In many cases it is the strategic incorporation of certified physician assistants (PA-Cs) to provide more focused care to the patient, to assist and coordinate the patient hand-off process and to improve communication with other providers, patients and their families.
Focus on the 80/20
There is a real need for focus since it is widely reported that 20% of patients account for 80% of healthcare expenditures. Patients are living longer and presenting with more complicated conditions. It is these elderly, ill patients that need healthcare management and coordinated services not only in the world of primary care, but also along the post-acute continuum. This is where certified PAs can make a difference, by keeping patients out of the hospital, avoiding unnecessary admissions from the emergency department and reducing 30 day readmissions to the hospital.
Length of stay and re-admission rates are critical metrics for organizations as they transition from the volume to value-based care models necessary for optimal reimbursement in today’s marketplace. In addition, as healthcare costs continue to spiral, high quality, cost effective, coordinated care is the only sustainable model.
Expanding role of PA-Cs
PA-Cs are uniquely qualified to provide the support needed at SNFs today. According NCCPA’s comprehensive workforce data, there are more than 108,000 certified PAs. More than 70% are providing direct patient care services in non-primary care specialties. This includes almost 14% working in emergency medicine, 19% in the surgical subspecialties; and 4% in hospital medicine.
Most major hospital systems employ certified PAs throughout their organization. Over 37 percent of certified PAs list the hospital as their principal clinical setting. An increasing number of hospitals brought PAs into the post-acute care settings or are exploring ways to do so, especially in affiliated SNF programs. Hospitals recognize that PAs, because they are educated in the same medical model as MDs, are uniquely qualified and equipped to help support and facilitate readmission avoidance, quality and patient satisfaction initiatives.
PAs are an important part of the team-based approach to care that has been shown to be cost effective and resulted in improved patient satisfaction and desired patient outcomes — ensuring steady reimbursement for hospitals. PAs also help offset the current and projected physician shortages. According to the American Association of Medical Colleges, the U.S. may be short 46,000 to 90,000 MDs by 2025. In addition, PAs cost less to employ—hospital medicine PAs earn an average salary of $105,000/year versus $217,000 per hospitalist M.D.
Steps to Take
Here are ways post-acute facilities and programs can make sure they maximize and expand the value PA-Cs can bring to their programs:
Research what are the root causes of readmission. How do your re-admission rates compare to industry benchmarks and others in your community?
Honestly examine your current approaches to reducing readmission. What programs are in place? What results have they achieved?
Look at areas of need in the organization. Are you utilizing the services of PAs in your current program? Can PAs exert leadership and spearhead change in a well-defined patient impact area?
Match your patient population needs with the skills and experience of your staff PAs, whether it is specific experience in hospital medicine, intensivist training, geriatric care or post-acute care. Certified PAs are well prepared to impact patient outcomes.
In addition, PAs may elect to earn an additional credential, the Certificate of Added Qualifications (CAQ), in seven specialties, including hospital medicine, emergency medicine, orthopaedic surgery and cardiovascular/thoracic surgery, which may bring additional patient care leadership to your skilled nursing facility.
Create an empowered team consisting of MDs, PAs, RNs, case managers, etc., who are committed to the coordination necessary to reduce readmissions and improve overall quality of care.
Focus PAs on specific services such as communicating with patients and families; and discharge planning, including the hand-off phase between the hospitalist and post-acute facility. If your organization is part of a system with hospital and post-acute facilities, look for ways for the PAs to work in both institutions to ensure continuity of care and better communication.
Get creative. For patients discharged from post-acute settings, use PAs to make house calls. Such an approach is more cost-effective than readmitting and leads to better patient engagement, adherence and satisfaction.
PA-Cs can address future challenges
The issue of how to better care for our sickest patients, especially as they travel the continuum in and out of post-acute settings, will only increase in the years to come. Seniors now make up the largest patient demographic, and that will be growing through the next two decades.
The organizations that survive, and even thrive, will be those that know how to manage post-acute care in a way that improves quality of care, reduces the need for high cost health services and lowers readmissions. PA-Cs are already proving that they can be an important part of that strategy and its success.
Dawn Morton Rias, Ed.D., PA-C, is the president and CEO, National Commission on Certification of Physician Assistants, the only certifying organization for physician assistants in the United States.