10 things hospitals should know about their post-acute partners

Skilled nursing facilities have spent the last few years learning a great deal about the hospitals they work with. Almost every day, you can find a new seminar, Web training or conference on the subject.  Most of the expense by nursing facilities on learning how to partner with acute care is money well spent.  After all, if you don't understand who you are working with, or more importantly, who you will be sharing risk with, how can you expect sustained success?

As all of us working in the ever tightening healthcare continuum are finding, getting to know each other in a more comprehensive way is vital to long-term survival.  From a post-acute perspective, there are 10 things that providers would appreciate their acute-care partners taking a look at.  This closer look will benefit us all as we successfully negotiate this new world.

1.  We know more than you think. There was a time when the hospital would be correct in thinking that we in the post-acute and skilled nursing world were out of the loop.  That's changed in a big way.  Now, we are starting to use some of the same resources and tools that the hospitals are using.  We are partnering with the big data and analytic providers you know by name. In fact, we are studying hospital data from a variety of outlets.  We are joining acute care professional organizations where we can, learning what the world looks like from your perspective.  We are attending regional and national conferences with our acute-care providers.  You are starting to see more of us, and not just in the exhibition hall. And when we have downtime, we are catching up on our print and email professional publications, including some of the same ones you read.

2.  We are upgrading our facilities too. Hospitals in our markets have been investing a great deal of capital to stay competitive. We may have started a little later than you, but so are we. We are eliminating semi-private rooms where we can. We are creating transitional care suites, with in-room bathing and cohorting like patients together. All in all, our capital improvements are designed to enhance services, like creating an environment conducive to more hospitality focused programs and upgrading the dining experience.

3. We have computers on wheels. Hospitals are ahead of most of us when it comes to implementing EHRs. But we are catching up quickly.  We are implementing our own EHRs and looking at bridges between our systems and the hospitals. Wi-Fi, Internet and e-signing of orders is becoming the new normal. We are even charting with COWs to integrate care and accountability. In many markets, we're also using an electronic referral process to help with communication. We can share lab and other test results.

4. We want to see our physicians as much as you want to see yours. Many of us have engaged a SNFist strategy to manage acuity. You have a hospitalist; we have a SNFist who has comparable training and education. SNFists and extenders provide us with coverage up to seven days per week. In many instances, they make patient visits within 24 hours of admission. They also collaborate with attending physicians to reduce readmissions to the hospital.  For example, one 240 bed facility saw its congestive heart failure readmission rate of over 40 percent fall to less than 10 percent over a six-month period once a SNFist strategy was implemented.

5. Our goals are aligned. In the post-acute world, we believe in continuity of care and reducing readmissions. We can triage new symptoms and provide for changes in care. We can handle high acuity and utilize resources like a peripheral inserted central catheter nurse, Pxysis machines providing access to new medication orders, and therapy provided seven days per week. Our staff training and ratios continue to increase to levels far beyond the traditional nursing home requirements.

6. We are learning how to avoid your emergency department. Where we can, we look for opportunities to avoid the ED and send appropriate patients directly to us. We think more and more commercial providers will begin to look at us this way too. We can create an admit unit. If our patients do go to the ER, send them right back; we can manage the care. There are continuous process improvement initiatives around ED transfer process inside the post-acute setting. We've mastered CHF, pneumonia, and myocardial infarction. Now we are preparing for the next set of penalized diagnosis-related groups.

7. We track data including our own and data related to hospital outcomes. We monitor physicians' compliance through benchmarking. We offer to share our data with hospitals. In many settings, we are part of a hospital's post-acute provider networks. We are providing more information than is often requested to help you get a clear picture of our efforts and results. We are also comfortable with data analytics and comparing and benchmarking our results.

8. We are aware of the future opportunities and challenges of bundled payments. Have you assessed your SNF providers for readiness? Most of you probably know that CMS has started a pilot program for post-acute providers to participate in bundled payments. As a result of that and other patient management strategies, post-acute providers are lowering the average length of stay.   

9. If you open us up, we can still appear on your cost reports.  If you have a SNF as part of your hospital, how does it integrate with your future strategy? It may be time to reconsider opening up that skilled unit you thought no longer compliments your strategy. Are there challenging diagnoses that your SNF partners are still having difficulty managing? Could you manage these diagnoses inside your campus as part of a SNF strategy?

10. You haven't visited us in a long time. We would love to show you how all of the changes listed above are helping us be better partners. We'd like to share more with you. There is so much going on that is all about partnering. Communication between all of us along the health care continuum keeps getting better but can still be improved. We encourage you to learn more about your post-acute partners and let us help you build your strategy.

If we could leave you with one message, it's that we are seriously preparing for the future and our goals continue to be aligned.  We are excited about a future of aligned goals and a better patient experience for all of those we serve.

Charles Ross is an experienced strategic post-acute care operator and business development professional with a history of maximizing results and creating high-level partnerships across the healthcare continuum.  In his role at Transitional Care Management, he works closely with hospitals, home health, hospice, and skilled nursing, including a focus on managing new purpose-built stand-alone post-acute care facilities. 

Sarah Glumm is a senior level executive with extensive experience in acute care, acute rehabilitation hospitals, and post acute care including hospital based skilled nursing units.  In her current role at Transitional Care Management, Sarah blends her experience in the continuum to create successful clinical programs that meet the needs of today’s patients and providers.


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