John O'Connor

Most of us are all too aware of our professional friends and enemies. But not so much when it comes to our “frenemies.”

For those unfamiliar with the term, frenemies refers to other people and organizations that are enemies pretending to be friends, as well as organizations that really are friends, but also rivals.

Given the many changes taking place in healthcare today, the frenemy list for many long-term care operators is expanding as never before.

Let’s start with hospitals. Many a provider is desperately reaching out to acute care providers, in an effort to gain acceptance into various health networks’ circle of friends. Such outreach makes good strategic sense. After all, hospitals have historically been the primary source for new residents. And in the emerging world of accountable care organizations, hospitals will definitely need a few reliable skilled care operators they can count on.

So hospitals are friends, right? Not so fast. Many of these same business partners also feel they are shipping too many of their post-acute patients to your beds. Figuratively speaking, they would kill to find a cheaper alternative, such as home care. At least, I think that’s figuratively.

And if you think hospitals make for fair-weather friends, just wait until you see how the managed care companies are going to keep turning the screws. In addition to doing everything possible to limit your payments, they’ll keep looking for alternative post-acute placement settings as well, for the same reasons.

Then there are the homecare operators. Yes, they may have been a traditional resident source — and may continue that role in the future. But make no mistake: They are looking at your residents in much the same way that a pack of wolves sizes up a lost baby elk: as easy pickings. The rules of the road have changed. And if you don’t think they are trying to convince hospitals to take the SNF bypass and give them a try, you just haven’t been paying attention.

Then there are the assisted living facilities, another traditional feeder. To their credit, they have always made their intentions clear: They just don’t like skilled care settings. Their old marketing brochures are chock full of words like autonomy, choice and independence. Problem is, many of the residents they take care of these days fit the profile of nursing home residents circa 1994. So they are providing more intensive memory/dementia care, falls care, and other quasi-healthcare services that dance on the medical service periphery — without the hassle of having to meet medical licensure requirements. And oh, by the way, many of these buildings are now full of licensed medical professionals. Yes, it’s a new era.

So what does this mean for SNF providers? Game, set, match? Not exactly.

At last week’s NIC opening session, Dr. Thomas H. Lee gave an interesting preview of how he believes healthcare will look in the years to come. He repeatedly noted that the role of strategy will dramatically increase.

According to Lee, the chief medical officer of Press Ganey Associates, organizations can survive and thrive by differentiating how they efficiently deliver value. As a practical matter, that requires a commitment to measurement, an ability to improve, becoming more transparent, understanding the full value chain for your residents and cooperating/collaborating/integrating, he noted.

But don’t kid yourself: All those things are easier said than done. And should you try to follow his prescription, you might wonder if the good doctor is really a masochist at heart.

In fact, he may one of your organization’s few real friends.


John O’Connor is McKnight’s Editorial Director.