Success amid today’s long-term care (LTC) financial front may not lie solely within your own ledgers—it might be right down the street. Increasingly, the win-win factor for long-term and post-acute care facilities is in making the right community friends, and in partnering with the right local service partners before your competition does.
All LTC facilities know that the best ongoing boon for census is a great relationship with the local hospitals. All those local referrals mean census dollars for skilled nursing, assisted living and outpatient therapy services.
But hospitals, under huge regulatory scrutiny and budget constraints of their own, are now choosing to streamline their own risks by selecting their LTC outsourcing partners much more wisely than in the past. Hospitals are now seeking LTC/post-acute partners who are technologically ready and on board to help them achieve documentation compliance under the Centers for Medicare & Medicaid Services’ new quality initiatives for hospital readmission, transitions of care, infection control and other programs.
It’s a fact: The old skilled nursing foothold is shrinking, from the outside in. Hospitals that used to send referrals to multiple skilled nursing facilities (SNFs) are now beginning to contract with specific local SNFs whose business practices clearly align with the hospital’s own, narrowing the referral field significantly, noted Clint Maun, CSP, president and senior partner of Maun-Lemke Speaking and Consulting, in a recent Long-Term Living webinar. Hospitals also are beginning to send more patients straight to a home healthcare partner, skipping the SNF altogether, Maun added. In order to compete, SNFs must be willing and able to admit people “quicker and sicker,” he said. In addition to dealing with volume and length of stay, “you might need to get into chest tubes and ventilators in order to take the patients you need to take.”
Some of the biggest mistakes an LTC facility can make lie within the staff workflow patterns, many of which begin at the front door, Maun added. “How long does it take your staff to say yes to an admission?” he asked, “because 95 percent of the time, anything more than 15 minutes is too long.” And, these days, few hospitals will want to partner with you unless your own readmission rates are less than 10-12 percent, he added.
Another mistake is not being able to offer competent staff and full-service lines during the weekends. “We’re not going to stay in business if we’re still using the old ‘nursing home’ model. [The new model for] Medicare is about what happens on Friday, Saturday, Sunday and Monday, not just on Tuesday, Wednesday and Thursday,” said Maun. Those 24/7 services need to include occupational and physical therapy, he added.
Finally, SNFs need to realize that the integrated team-based approach is the ideal in today’s person-centered care world. The old SNF job-role silos are long outdated, yet many SNFs are still grappling with this change environment, Maun said. The secret to building great SNF care teams is to include some change-makers, some data-gatherers and some down-in-the-trenches caregivers all on the same team, he suggested.
Making the most of productive partnerships means embracing new marketing strategies. LTC marketing departments must be well trained and aggressive when it comes to seeking new hospital referrals, said Kenneth Cohn, MD, MBA, in a presentation at the 2013 ALFA Conference. “We have to get out of our separate camps and learn how to work together in ways we never have,” said Cohn, who also is a surgeon.
Some of those goals are easier than others. SNFs are accustomed to tracking their own successes and failures in infection control, wound care and medication compliance, but sharing/marketing those data successes to prospective partners can be a challenge without the right data systems in place.
Many SNFs and assisted living communities also miss the golden opportunity to trumpet their acute-care partnerships among the greater local community, such as shared initiatives for clinical risk with an acute-care partner, shared initiatives for chronic disease management and shared community outreach on wellness programs, Maun added.
The bar is set high for long-term and post-acute care providers now; and it will get even higher, based on the assurances some hospitals are already giving to their patients. The Geisinger Health System has now begun to “guarantee” its cardiac and orthopedic surgeries, deciding that patients should not be charged extra if they have to be readmitted to a hospital—and that includes the partnered SNF stay, Cohn noted.
If not, please step out of the queue. Hospitals no longer have room for LTC partners who aren’t ready to receive electronic health record and discharge planning data, especially under Medicare’s penalty-bearing initiatives for patient “transitions of care.” And the healthcare industry’s expectations of technology have already moved beyond this: Many hospitals now prefer LTC partners who can exchange data in a bidirectional way, thereby keeping the “transitions of care” records solidly intact, just in case a resident is readmitted to the hospital later, especially under the Medicare-crucial 30-day or 60-day time frames.
“Long-term care must realize that readmissions are increasingly being viewed by acute care as “defects to be eliminated, much like the ‘never events,’” Cohn explains.
Similar message were delivered at the 2013 Long-Term and Post-Acute Care Health IT Summit, where multiple speakers suggested that, in some ways, the Medicare/Medicaid demonstrations should be viewed as over now—bundled payment models and risk penalties have become real life, and therefore so has the new model of shared risk between acute care and long-term/post-acute care for resident outcomes and readmissions.
Ready or not, the new business models for skilled nursing and assisted living will lie within making the right partnerships for the right services—one community at a time.