Skilled nursing facilities shouldn’t expect to see discharges return to pre-COVID levels soon thanks to a fundamental shift in how hospitals, health systems and other providers view the post-acute discharge process since the pandemic, several health experts predicted during a leadership panel Wednesday. 

“We [historically] would approach that next site of care through the lens of what level of care can we qualify somebody for? … If we could qualify them for a skilled stay, that’s where we took them,” said Mark Terpylak, D.O., senior vice president of population health at Summa Health. 

“We don’t do that anymore,” he added. “We fundamentally ask ourselves at the time of discharge from acute care, ‘Can we send them home, first and foremost, and support them in a home environment?’ If we can’t, then we work our way up the ladder in the other direction.” 

Terpylak’s comments came during a panel discussion hosted by the National Investment Center for Seniors Housing & Care. The conversation centered around SNF discharges and partnerships between operators and hospitals. 

He added that the shift in philosophy is in large part due to primary care providers focusing on better managing risks, medical spending and trying to move patients into lower cost sites of care. 

“It’s not because of COVID — although I think COVID certainly served as an accelerant — to kind of get people thinking this way and approaching it differently,” Terpylak explained. “If they’re not qualified for [home health], then we’ll send them to skilled nursing.” 

He later added, “But certainly when we make that decision to go to skilled nursing, we are looking very actively on an ongoing basis for those partners that share our values and are committed to providing care for those folks in the most cost-effective fashion.” 

His colleague Bryan Crum, director of post-acute care management at Summa Health, added that lower volumes of patients, which means fewer downstream referrals to SNFs, is driving the philosophy shift, as well.

“We were in a situation where we kept on having more and more people come in the door, we needed beds for them, and so we needed to discharge folks. We kind of changed our mindset to: ‘How do we get these people to go home?’” Crum explained. 

“That’s something I don’t think switches back,” he added. “I think we’re going to have a new normal. That new normal is going to likely be less admissions for the hospital and I think that’ll be more compounded for some of the skilled nursing in the community.” 

The decline in volume doesn’t mean that hospital partners should completely abandon their relationships with SNFs. Rather, they should tighten their collaborative partnerships and focus on sending their referrals to their preferred providers, according to Bryan Cloch, principal at Innovative Health, LLC. 

“We still have a big need for the right level of care at the right time, and there’s certainly still a place for skilled nursing,” Cloch said. 

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