In the rapidly changing healthcare delivery system, SNFs will need to implement strategies to integrate physicians to retain their market share and be competitive. The incentives inherent in value-based reimbursement necessitate a transformation on the part of SNFs. They must deliver and prove value to form partnerships with hospitals; to accomplish this, they must find a way to change how they work with physicians.
This represents a sea change for most SNFs. Traditionally, SNFs do not have regular or on-site physicians. Visiting physicians do not generally visit every patient. Physicians often learn of changes in patients’ conditions over the phone, which often results in miscommunication. Many attending physicians also are unaware of the clinical capabilities of SNFs and their staff. This means physicians often question the SNFs’ abilities to address patients’ clinical needs and thus can lead to perhaps unnecessary orders for hospital readmission.
As most SNFs know by now, the overall effect of most of the ACA reforms is to displace the risk for cost and quality for episodes of care – that is, the care provided in more than one setting – to the provider level. This puts SNFs in the position of having to prove their ability to achieve high quality at a lower cost, to manage the transitions in care, and to work in much closer partnership with up- and down-stream providers. This is challenging, particularly when considering the frail and medically complex group of Medicare beneficiaries who use SNFs, and especially considering the remote role of physicians.
However, hospitals are now narrowing their network of post-acute care providers using scorecards (such as the Avalere Vantage Care Positioning System (CPS)™ Post-Acute Care Scorecard) that evaluate performance along many dimensions. Hospitals will evaluate SNF ability to help them identify and reduce variation in costs and quality. And, they will expect SNFs to integrate physicians into their clinical teams in order to perform more efficiently and at a higher level of quality.
While physician integration is challenging, we identified some strategies SNFs can follow to bridge the gap in how they work with physicians:
- Get Physicians In Your Buildings: Inconceivable in the recent past, some SNFs are now hiring physicians. This is the easiest way for SNFs to improve how they relate to physicians. They hire them full-time or part-time and fill gaps with nurse practitioners and physicians’ assistants. One study from Life Care Centers of America, based in Cleveland, shows that this strategy has positive results: buildings with a full-time physician show a decrease in readmissions of 12% to 13%.
- Maximize Physician Value Through Improved Communications: Another way SNFs can improve their relationship with physicians is by strengthening their own internal communications processes with physicians in mind. Physicians need information presented in a concise and prioritized manner. This can be achieved through a simple strategy of training staff to identify high-risk patients on a daily basis to with the goal of prioritizing medical intervention. This not only can help SNF staff members use their time efficiently but can maximize the time when physicians are in the building.
- Don’t Be Afraid to Go Digital: SNFs also can increase efficiency through standardized tools like INTERACT and through providing physicians with access to the SNF’s electronic health records system. These strategies not only demonstrate the credibility, quality and clinical sophistication of SNFs; but, they also allow SNFs to work with physicians to build clinical protocols related to specific conditions and to measure, evaluate and share the results of clinical care. While there are worries about integrating an EHR with external systems, most SNFs find the benefits of transparency with physicians outweigh any initial problems. At the very least SNFs should provide physicians with read-only access and work with technology vendors to fix compatibility issues.
- Attract Physicians through Refined Clinical Protocols: SNFs also should work continually to refine their clinical protocols and build core clinician teams. Physicians are more likely to be drawn to a SNF if it shares some of the clinical sophistication of an acute care hospital.
- Embrace the Power of Data: One part of these refined protocols should include harnessing SNF data. Tracking important metrics like readmissions, infections rates and other key outcomes at multiple times during a patient’s stay can help a SNF market itself to potential partners and also to assist in assessment of the impact of facility-level interventions. Strong data can help a SNF not only establish and track physician engagement efforts and preferred partnerships with hospitals and health systems but it also can help SNFs perform analyses for negative outcomes in conjunction with physicians and other parties.
In all, most SNFs will find that these strategies will work together to engage physicians in the process of patient care and to reaffirm their trust in its efforts toward quality improvement. These strategies also will serve to strengthen the value and position of SNFs to hospitals and give them a leg up in an increasingly competitive market environment.