A hospital-to-skilled nursing conversion project uniting ProMedica and Cleveland’s MetroHealth Health System is the first of several collaborations the giant senior care operator is planning to launch this year. It’s part of a push to increase clinical capabilities and attract more medically complex patients or short-term rehab referrals.

David Parker, President of ProMedica Senior Care

ProMedica Senior Care, formerly known as HCR ManorCare, is in separate talks with four other health systems to coordinate skilled nursing care in proven markets, relying on a groundwork of quality metrics, David Parker, division president, told McKnight’s Long-Term Care News last week.

“We wanted to partner with health systems to ensure that they had skin in the game, that they had ownership in those quality results,” Parker said. “They had ownership in volume through the skilled nursing center and managing that length of stay and that cost of care, for the right quality of care with the right outcome, at the right cost.”

The first partnership will take shape in Cleveland on MetroHealth’s Old Brooklyn campus, which by fall will be home to a new, 96-bed skilled nursing facility in what is now a dormant hospital. ProMedica Skilled Nursing and Rehabilitation at MetroHealth will feature all private rooms, an innovative therapy gym, new ventilation, isolation units with remote monitoring capabilities and an in-building geriatric practice.

It will be part of a senior services hub that includes a research program for spinal cord injury and stroke survivors, organizations that target social determinants of health and, possibly, a food clinic supported by ProMedica’s charitable foundation.

Tearing down walls

About seven years ago, HCR ManorCare undertook a similar partnership when it answered ProMedica Health System’s request for proposals to manage a nearly 50-year-old skilled nursing center in Sylvania, OH.   

What emerged was a cooperative model based on quality, compliance, and clinical and financial results, as HCR ManorCare developed a replacement SNF and took over day-to-day management. Parker said that initial venture was so effective that it spurred ProMedica and Welltower’s $4.4 billion joint acquisition of HCR ManorCare in 2018.

At the time, ProMedica President and CEO Randy Oostra said the health system wanted to “take down the wall between traditional hospital and post-acute care services” and invest as much as $400 million in growth over the next five years.

But Parker wasn’t interested in buying facilities in unknown markets or companies with a history of poor performance that would need significant capital investment. He sought other nonprofit health systems that would focus on quality measures and capabilities — not just overall 5-star ratings — when improving their vertical reach.

ProMedica and its insurance company, Paramount, had worked with MetroHealth previously in the Cleveland and Cuyahoga County markets, and ProMedica already had five skilled nursing facilities and a robust referral network there.

The new partnership will lean heavily on communication, with a joint quality committee meeting quarterly to discuss key metrics including clinical and rehabilitative performance and value. ProMedica is investing a “couple million dollars” in the project, Parker said.

“We really believe this is the first of many,” he added, noting letters of intent have been signed for other sites.

Chasing recovery

While Parker acknowledges pandemic-related disruption will continue through much of 2021, he’s taking the long view — and making clear ProMedica’s strategy revolves around higher-needs patients.

The ProMedica Senior Care division has more than 350 locations across the care continuum in 26 states, with 168 skilled nursing facilities. Its revenues fell $385.4 million between December 2019 and December 2020, accompanied by a 12% occupancy decline.

Early this month, the company announced it is divesting 25 “non-strategic” properties, spinning the proceeds from those into a 20% share in nine PowerBack facilities previously operated by Genesis HealthCare. ProMedica will operate them in a new Welltower joint venture, with temporary management beginning by May 1. The deal boosts ProMedica’s operating performance by about $40 million and puts cash on the balance sheet.

The PowerBack facilities, valued at $292 million, are designed for clinically complex patients who get “aggressive” physical therapy and a promise of shorter stays. They are similar to ProMedica’s Medbridge, a dedicated short-term care brand that requires facilities to hit specific clinical and rehabilitative targets. 

“These are A class assets,” Parker said. “In skilled nursing, they are probably some of the best assets that are purpose-built. They are private rooms. They’re in outstanding marketplaces in which we already have centers and operate, so they will be very accretive.”

ProMedica, which drew 34% of its census from Medicare and managed care before COVID-19, is adding clinicians and technology and focusing on data-sharing to ensure it continues attracting those more lucrative referrals.

A network of more than 300 advanced nurse practitioners, for example, will soon be supported by a new physician operation dedicated to skilled nursing facilities. In many states, physicians will be on-site five days a week.

Moving patients ‘at the right pace’

The larger ProMedica organization is also wrapping up an 18-month effort to make electronic health records used by its physician office groups, hospital and senior care settings fully interoperable. ProMedica is investigating remote monitoring tools that will feed vitals directly into the system to reduce work stoppages and time spent on documentation.

“We believe that will be a game change to ensure there’s continuity of care between acute care upon discharge and upon admission into the skilled nursing center,” Parker said. Many of the same strategies will be used in Toledo, where ProMedica’s “skilled nursing facility of the future” gets under construction next spring.

The systemwide ultimate goal is to move patients through the care continuum “at the right pace,” an effort Parker said can’t be left for hospitals to navigate with home care providers alone. Even as ProMedica developed robust hospital-at-home strategies during COVID-19, it was working behind the scenes to ensure its bricks-and-mortar business bounces back in the months and years to come.

Parker said there will be focus on markets, including Chicago, Detroit, Baltimore, New Jersey and Washington, D.C., where ProMedica already has portfolios with four or five buildings.With again Baby Boomers, demographics also count. Many aging patients will still need nursing homes after surgeries or major medical issues, Parker said.

“People will be there shorter amounts of time … but that’s been happening for a number of years. That’s really been the sweet spot for ProMedica Senior Care and for legacy HCR ManorCare,” Parker said, noting average Medicare lengths of stay of 19 days pre-COVID. “You’re basically running a skilled nursing facility the way a restaurant looks at turning tables during the night.”