McKnight's Guest Post - Acute care and Post-acute care: A friendship long overdue

Steve Carr and Jeff Jacomowitz provided this piece to McKnights

- May 17, 2017

As featured on McKnights

In our modern era, relationship between community hospitals and nursing homes and other post-acute care facilities have grown closer than any time in history. Why?  Survival. 

Simply, both acute care facilities and post-acute care facilities need each other to thrive in today's world order as the bulk of the population grows into their 60's, 70's, 80's and 90's. As this happens, what can be said for the generations following them?  Wouldn't that be the million-dollar answer to a creative million-dollar question?    In order to answer, one needs to know hospitals benefit nursing homes and vice versa. 

Let's look at the five major areas.

  1. The Importance of Value-Based Payment (VBP)

    VBP is a model used by purchasers to promote quality and value of healthcare services. All in all, the goal of any VBP program is to shift from pure volume-based payment, as exemplified by fee-for-service payments to payments that are more closely related to outcomes. Before the introduction of Value-Based Payment, hospitals had little reason to consider how local nursing homes would affect their performance.  Now, hospitals and nursing homes have many reasons to work with one another.

    Hospitals that participate in accountable care organizations or bundled payment initiatives have a powerful incentive to work closely with nursing homes to improve patient care, control costs and reduce readmissions. According to the Hospitals & Health Network for 2015, nationally about 18% of all patients discharged from hospitals to nursing homes are readmitted within 30 days.

    Medicare began penalizing hospitals that have high readmission rates back in the fall of 2012. A year later, the efficiency score announcement surfaced with the 2013 announcement of an efficiency score, defining Medicare Spending Per Beneficiary or MSBP.  The idea was that this efficiency score was added into the value-based payment formula, used to calculate hospital payments. The MSPB includes all spending for a patient care episode, starting three days before an inpatient admission and ending 30 days after discharge. That means hospitals are held directly responsible for the costs incurred by Medicare to patients discharged to nursing homes.

    Medicare began penalizing hospitals that have high readmission rates back in the fall of 2012. A year later, the efficiency score announcement surfaced with the 2013 announcement of an efficiency score, defining Medicare Spending Per Beneficiary or MSBP.  The idea was that this efficiency score was added into the value-based payment formula, used to calculate hospital payments. 

    The MSPB includes all spending for a patient care episode, starting three days before an inpatient admission and ending 30 days after discharge. That means hospitals are held directly responsible for the costs incurred by Medicare to patients discharged to nursing homes.

    Based on Avalere's Vantage Care Positioning System analysis of the 2015 Medicare Fee-For-Service file, 43% of all national hospital discharges were followed by a post-acute care stay which includes, skilled nursing, home health, long-term care hospitals, inpatient rehabilitation facilities, other inpatient hospitals and readmissions. In New York, by comparison, 46% of discharges from short-term acute care hospitals are followed by a post-acute care stay.

  2. Episode of Care

    Hospitals and health systems are increasingly shifting their focus to managing an episode of care. This focus has drawn attention to “what happens to the patient after they are transferred from the acute care setting." Care coordination along the continuum is critical to improving episodic outcomes over a 30-, 60- or 90- day period of time. 

    Hospital and skilled nursing lengths of stay have been reducing for several years resulting in a reduced amount of inpatient care for many conditions. In order to improve outcomes, it is necessary for hospitals, physicians and skilled nursing provider to invent new ways of delivering coordinated care.    

    It is important to be actively engaged with hospitals around pathway development and care management strategies that are focused on delivering high quality, coordinated care. The goal is to extend the acute care plan of care into our centers.

  3. Hospitals are being forced to manage utilization along the continuum:

    Many of the current VBP and alternative payment models penalize and reward hospitals for the outcomes associated with episodic care. As such, hospitals are increasingly focusing on where patients receive care along the episode of care. As hospitals focus on these measure, post -acute outcomes become critical to achieving success.  

  4. Narrow networks of post-acute partners would be beneficial to providers for improving quality of care.  

    In order to better manage care coordination, narrow networks are becoming the norm. Becoming a valuable partner in these networks requires a commitment to quality metrics, investments in care redesign and time. Our most productive hospital relationships involve monthly quality reviews where our people are meeting with our acute care partners in order to review real time results and to discuss how we can do better. Various tactics for improving care between acute and post-acute partners include warm handoffs, which serve as the first step toward accountable care.  

    This involves actual real conversations, not just the exchange of paperwork, between clinicians on both sites.

  5. Skilled nursing centers offer a wide range of options at a value price.

    SNFs offer hospitals a wide range of solutions. Within the skilled nursing space a hospital can partner with a SNF provider in many areas. From chronic disease management, post-surgical care, palliative care to long term dementia care, skilled nursing facilities are equipped to work together with hospitals for almost any kind of patient seeking post-acute care.  

    Skilled nursing centers also still deliver care at a lower price than other options such as LTACH's and IRF's.  As hospitals shift more care into the community setting, providers that can offer this wide range of care become more valuable.   

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