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Progressive SNFs make good partners for hospitals under healthcare reform: SNFs step up to the challenge of keeping patients healthier and out of the hospital

As hospital and health system C-Suite leaders grapple with the sea change in healthcare reimbursement, forward-thinking skilled nursing facilities can make ideal partners. Today's SNFs can help hospitals decrease readmissions and avoid penalties by keeping post-acute patients healthier and out of the hospital. National Post-Acute Healthcare is working with SNFs to build strategic relationships that can help hospitals meet some of the challenges of healthcare reform.

One quarter of nursing home patients are readmitted to hospitals.
SNFs no longer serve chiefly as homes where the elderly spend the rest of their lives. Many NPH network SNFs report that over 80 percent of their admitted patients go home.

However, nearly one quarter of these patients experience acute flare-ups of their chronic conditions during their nursing home stay. Urinary tract infections, congestive heart failure, respiratory infections, sepsis and electrolyte imbalance are among the chief culprits. Further, until recently, those flare-ups often entailed an ambulance ride back to the hospital.

Anticipating that healthcare would begin to reward providers who can keep patients healthy and out of the hospital, NPH's network of SNFs have cut readmissions to as low as 8 percent, well below the national average of nearly 25 percent in fiscal year 2011.1 They achieved that with a combination of unique measures that included:

  • Creating higher acuity care units.
  • Using enhanced clinical protocols and care pathways.
  • Hiring advanced practice nurses, care managers and specialized physicians.
  • Mining EHR data to anticipate problems before they significantly affect health.

Step Up Units and improved care coordination
Our network of SNFs created the concept of a special Step Up™ Unit that can provide a higher acuity of care — including such services as IV antibiotics, oxygen, and respiratory therapy — thus preventing a trip back to the hospital for these services.

Other changes included increasing the frequency of physician visits, hiring nurse practitioners to provide better oversight of patient health, and creating protocols and care pathways in conjunction with hospital partners to improve care coordination.

Anticipatory care and data mining
Another key to keeping patients healthy and out of the hospital was creating "anticipatory care," with the assistance of sophisticated software and a data-mining program that interfaces with the SNF's medical records system. It's critical not just to collect data but to analyze or mine it in real time for the factors that flag a potential problem before it becomes a major health issue.

To detect problems in real time, NPH's founders invested over $1 million to develop proprietary software and then launched a software company called Real Time Medical Systems that today serves more than 100 facilities under contract.

Daily patient reports include 130 different measures. If a patient is not drinking, eating or voiding as usual, the system flags this problem in our daily nursing reports. Hospital-level nurses and nurse practitioners, plus more frequent physician visits, allow the SNF to respond quickly to these red flags and address them before the patient develops a serious health issue.

CMS bundled payments foster hospital-SNF partnerships
In 2013, the CMS named 24 healthcare organizations to participate in their Bundled Payment for Care Initiative Model 3 initiative, in which participants or "conveners" have both financial and performance accountability for episodes of care to increase quality and lower costs.  That aligns incentives for hospitals, post-acute care providers and physicians, as well as improving care coordination across settings.

NPH's SNF Network member, Mid-Atlantic Healthcare, was among the first group of conveners in 2013, with five of its SNFs going live in 2014. We're now managing the engagement of some 200 SNF and home health agencies in the BPCI that anticipate going live in 2015. NPH provides training and support to facilities that join its network and commit to improving care. In addition, we negotiate shared savings contracts between that network and the hospital or health system. The goal is to share a portion of the savings that accrue to the hospital by reducing readmissions.

Helping hospitals meet meaningful use stage 2
SNFs also can help hospitals meet one of the core objectives of stage 2 of meaningful use and avoid penalties that may begin accruing as early as FY 2015. Core objective No. 12 in stage 2 requires hospitals that are transitioning patients to other settings of care to provide a summary care record for at least 50 percent of the care transitions. SNFs that are prepared to accept electronic data, like those in the NPH network, will be ideally positioned to help hospitals meet that objective for stage 2. 

Of course, not all SNFs are able to partner in these ways with acute-care providers. The challenge for hospital and health system executives is to identify and contract with the providers that can offer solutions. 

Rick Grindrod is the CEO of National Post-Acute Healthcare and former CEO of Erickson Retirement Communities. He can be reached at rickgrindrod@nationalpostacute.com. Visit nationalpostacute.com for more information.

 1OIG Report, November 2013, “Medicare Nursing Home Residents Hospitalization Rates Merit Additional Monitoring”

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