SNF survival in an aging society

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By Alan Abrams, M.D., MPH
By Alan Abrams, M.D., MPH

With the prevalence of multiple chronic conditions rising to three in four of those aged 65 and older, we face a ballooning number of people within the largest category of total Medicare spend – those requiring costly, ongoing medical care.

These beneficiaries have more options. Some choose to participate in programs that use some form of value-based payment methodology, and others opt to remain in traditional fee-for-service Medicare plans.

Whether beneficiaries participate in traditional fee-for-service Medicare, Medicare Advantage Plans or Medicare Accountable Care Organizations, the goals are the same: Better outcomes, lower costs and improved patient experience of care. To fulfill these aims, providers and payers invest in technology and infrastructure that enables patients to receive the right care, at the right place, and at the right time. When these stars align, healthcare organizations and providers have the potential to earn financial rewards for meeting benchmarks in risk-sharing arrangements.

Among the many cost drivers for Medicare programs, expenditures associated with hospitalization and post-acute care are among the most significant. The ultimate objective is to prevent unnecessary hospital stays, while facilitating a smooth transition for patients back to their community healthcare providers. However, many Medicare beneficiaries experience deconditioning or functional compromise during their hospital stay, and the safest and best alternative is for them is to spend a short period of time regaining their footing in a rehabilitation facility before transitioning back to a community setting.

With new performance-based payment methodologies for long-term care providers, skilled nursing facilities face increased pressure to reduce length of stay, requiring faster delivery of clinical information from discharging hospital to SNF, and from SNF to community providers. At the same time, hospital reimbursement methods promote discharging patients more rapidly and at higher acuity levels, resulting in an ongoing need for skilled services to achieve higher quality outcomes.

SNFs also face new performance pressures, including reducing length of stay and hospital readmission risk and improving Nursing Home Compare quality ratings in order to be recognized as a viable partner for discharging acute care hospitals.

In exchange for improving outcomes and lowering costs, SNFs may participate in bundled payment programs to enhance revenues. These marketplace changes require SNFs to generate a more secure and predictable volume of short-stay referrals to offset shorter average length of stays.

Although there's pressure to discharge patients faster, Centers for Medicare & Medicaid Services requires SNFs to bear some financial responsibility for potentially preventable hospital readmissions, as well as for meeting competitive new quality measures. Six SNF quality measures were recently added to those reported on Nursing Home Compare, and CMS is expected to demand more from SNFs in the near future.

Since these quality measures aren't risk adjusted, it could make comparisons among SNFs difficult for consumers and healthcare providers.

SNFs are under continuous pressure to provide value to their customers – hospitals, ACOs, bundle payment programs, health plans, patients and their families. In the past, SNFs could afford to operate as independent providers, uncoupled from referring hospitals and payors, making them somewhat immune to the need for analytic and health information technology tools required to succeed today.

Today, hospitals and SNFS can use discharge decision support systems such as The Right Place's communication and patient placement platform, which offers real-time clinical information and analytics on outcome-oriented metrics such as length of stay and readmission rates for individual SNFs. Operational analytics can help hospitals, SNFs and ACOs gain insight into referral patterns, acceptance rates, and occupancy, as well as track where patients are within a healthcare system. Tracking quality measures in real-time can help improve patient outcomes through consultation-liaison interventions or informed primary care providers.  By embracing technology, SNFs can remain competitive and be better positioned to improve outcomes and attain business goals.

SNF post-acute rehabilitation services are a critical part of the healthcare continuum for the growing number of seniors entering their Medicare years. While most of us prefer home as the default destination after an acute hospital stay, the lack of physical reserve of the more high-risk and frail aging population will continue to increase demand for post-acute care.

Keeping that part of the healthcare system vibrant and adequately available to meet the needs of our communities is critical. It will be important to improve efficiencies with technologies that help assess, refer, place and track patient outcomes at an affordable cost to ensure growing needs for long-term care can be met.

Alan Abrams, M.D., MPH is the Asistant Clinical Professor of Medicine, HMS, Beth Israel Deaconess Medical Center and former Senior Medical Director of the Beth Israel Deaconess Care Organization Pioneer ACO.

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