There are plenty of reasons to do so. Patients, caregivers, payors and regulators are ratcheting up the pressure on hospitals to be accountable for what happens to patients during the episode of care and in the period following discharge. Value-based payment will only intensify this accountability. This year, that pressure has expanded to the SNF community. In March, MedPAC recommended in its regular report to Congress that SNFs be held to the same readmission penalties that apply to hospitals, noting that “a rehospitalization policy for SNFs would create comparable policies for SNFs and hospitals, thereby encouraging providers in both settings to work together to better manage the transitions between them.”[1]
Although the post-acute marketplace has seen an increase in value-based partnerships between hospitals and SNFs, most of these partnerships lack the strengths to withstand increased market pressures. In particular, we’ve noticed three factors that can affect the success of a hospital-SNF partnership. They include:
1. Integrated business model. How integrated is your strategic partnership’s model? Hospitals and SNFs have a shared interest in ensuring smooth transitions between the hospital and the nursing facility and from the nursing facility to the patient home, but many leadership teams struggle with constructing the right model. Building appropriate organizational structures, negotiating financial and incentive terms, determining capital needs, setting up an effective integrated care model and making sure that model has the appropriate types and levels of staffing to deliver results are critical building blocks for these partnerships. Making sure you have the right tools in place to evaluate and build a successful, integrated model is paramount.
2. Complementary partnerships. Do you have the right supportive partnerships in place? Too often, health systems focus on the specific partnership with an SNF, or a preferred network of SNFs, without thinking about other supportive relationships that could factor into the model. For example, we’ve seen health system-SNF partnerships maximize aligned interests through the use of a network of embedded SNFists — primary care physicians or mid-level providers who deliver primary care services based on an evidenced-based care model in the SNF in much the same way as hospitalists within a hospital. In addition, home care must be aligned as a partner to ensure successful outcomes as the patient moves from SNF back to home. We have worked with SNFs to create “pods” of preferred home care to ensure the quality, outcomes and cost-effectiveness are sustained throughout the continuum. When you think about a partnership with an SNF, consider what additional networks will support and optimize that partnership.
3. Technology. Are you using technology in the best way to leverage the resources you have as efficiently as you can? Many health systems focus on integration of electronic medical records and billing systems when setting up a partnership with an SNF. Although these are important considerations, innovative partnerships leverage technology across the relationship: EMRs, financial and incentive systems, decision support systems, bedside technology and remote monitoring networks allow for the coordination of care from the hospital to the SNF and from the moment of discharge to the transition to office-based PCP for follow up. There are many ways your partnership can leverage technology to increase care quality and maximize efficiency: be sure to carefully consider all of them as you craft your strategy.
The reformed marketplace has opened up opportunities for innovative organizations to leverage relationships, implement care models and maximize shared interests to improve outcomes and reduce cost. Careful structuring of a health system-SNF partnership can optimize results.
Brent Feorene can be contacted at bfeorene@colonnadehealthcare.com or (440) 871-2756.
Footnotes:
[1] MedPAC. Report to the Congress: Medicare Payment Policy. March 2012. http://www.medpac.gov/chapters/Mar12_Ch07.pdf
More Articles on Skilled Nursing Facilities:
Leveraging Technology to Collaborate With the Community on Reducing Readmissions
Turning Heart Failure Into Heart Success: Transitioning CHF Patients to Home
ProMedica, HCR ManorCare Partner for Skilled Nursing, Rehab Center
