Tim Lehner, Consulate Health Care

The new chief operations officer of one of the nation’s largest nursing home chains is ready to throw the doors open to home health providers, citing collaboration as the best way to succeed and drive volume as hospitals prepare to shift to a mandatory bundled payment model.

At Florida-based Consulate Health Care, leaders anticipate the model will accelerate an ongoing trend of caring for patients with medically complex needs as hospitals work harder to reduce their acute-care spending. But COO Tim Lehner believes one key to keeping skilled nursing occupancy up — while pushing length of stay down — will be establishing reliable partnerships further downstream.

“We believe that home health should be in on the third day after admission to our building, versus the last day in our building, to plan that stay at home and to plan that smooth coordination, even if that’s going to reduce our length of stay,” Lehner told McKnight’s Long-Term Care News. “You’re not going to hear that out in general in the sector, but here’s why I’m OK with it: Because I believe it’s a volume business. If we get people home faster, we’re going to see that volume come back in. It allows us to coordinate that care in a much better and more efficient way, and the person that wins in the end is the patient.”

In an interview Thursday, Lehner and Chief Nursing Officer Andi Clark described how Consulate is investing in capital and technological improvements the company anticipates will be pivotal to a successful transition to a mandatory version of Bundled Payments for Care Improvement, of BCPI. 

The Centers for Medicare & Medicaid Services has indicated it will transition all hospitals to mandatory bundles covering an extensive range of conditions sometime after its final BCPI-Advanced initiative ends later this year. While most experts expect the agency to pull the trigger in late 2023 or 2024, skilled nursing providers across the country are already preparing for what could be the broadest value-based payment impact to hit the sector yet.

Faster bed turnover that still produces quality patient outcomes will be critical, Lehner said.

“In five years, under BCPI, you can make an argument that the most successful hospitals will be empty,” he said. “They’re going to benefit by getting that person out sooner. We’re going to benefit, which means our volumes in post-acute care go up. Therefore, we have to create capacity and coordinate that care. At that point, the responsibility moves to us, so we need to have like-minded home health providers, like-minded assisted living providers, like-minded hospices that are aligned with us in providing those services.”

Building clinical capability, tech for tomorrow

With 138 skilled nursing facilities in six states, Consulate is the nation’s sixth largest skilled nursing provider according to the American Health Care Association.

The company has already added specialists such as pulmonary, behavioral health, infectious disease and wound care experts in multiple markets, though a company spokeswoman acknowledged the effort was stalled by the pandemic. Now, the company is evaluating other ways to add clinical expertise to its staff. In the Southeast Florida market, advanced practitioners from GAPSHealth are in 10 buildings. In a handful of buildings in Louisiana and one in Northwest Florida, patients have regular access to nurse practitioners.

Leaders will use metrics such as patient outcomes, polypharmacy management and care transitions to measure which interventions are most effective. Of course, hospital readmissions also will be a key test.

“As we exit COVID, we’re going to make capital improvements and changes in our buildings as to how we communicate with the patient. It is going to evolve as disease processes evolve, as technology evolves, (especially) the ability to follow patients at home and in our setting,” said Lehner, hired last summer. “Are we having successful discharges? It’s not just about their time in the building. It’s 30 days after their time in the building.”

Viewing home health and other downstream providers as partners in care  — versus competitors stealing a share of the post-acute market — is a sea change. But it also provides opportunities that can redefine how caregivers and companies operate.

Keys to succeeding will be increasing clinical capabilities and empowering patients.

Consulate holds monthly educational calls for staff; rolled out a Journey Home program that takes a robust look at patient needs within the first 48 hours and assigns a friend or family member as a health coach for conditions such as diabetes, congestive heart failure and COPD; and developed clinical pathways that give staff day-by-day strategies to ensure patients get the resources they need and build an understanding of what they’ll need to do to stay well after discharge.

Adding prowess to prove worth

The shift away from providing custodial care to rehabilitating patients with complex conditions who move home to finish recuperating offers its own rewards to nurses. By providing more advanced care than in the past, they can help shorten length of and keep patients happy, Clark said.

Andi Clark, Consulate Health Care

“Medicine has grown and improved. We train a lot on meds and new techniques. Twenty years ago, we didn’t always do IVs in our centers or take trachs,” Clark said. “There are other technologies we are probably going to be seeing in centers as we move forward with these partnerships with our hospitals…. We’re preparing for that future.”

For Lehner, investing in the staff and equipment, such as remote monitoring, needed to elevate care is part of a long-term strategy. He predicts that becoming the “nursing home of tomorrow” by improving staff competency will deliver hospitals what they need— and reduce system-wide costs.

And as volumes go higher, so too will margins, Lehner said. But he’s telling his regional and building leaders to stop focusing on the money and consider the patient impact of a more collaborative approach.

“Our obligation is to advocate for the resident, to give the best quality services that they can possibly get in the setting that they prefer and that will get them that best outcome,” he said. “If we do that better than anybody else, we will have more patients than we will have beds available. That is the Consulate target. I may have some people today who don’t align with that, and they may need to go somewhere else, to be blunt. But I’m listening to my payer, which is my hospital, saying, ‘We are getting penalties. We need that post-acute spend down. What are you going to do about it?’ ”