An evolving market calls for new ways of thinking
By Laura Thill
The long-term care industry is changing, and quickly. As the market evolves into a post-acute-care environment, it’s essential that sales reps understand how this impacts their customers. Perhaps most notably, patient demographics are rapidly expanding. As hospitals discharge patients sooner and sooner, traditional long-term care and skilled nursing facilities must provide more services than ever before, from rehabilitation to assistance with activities of daily living.
“We define ‘post- acute’ as any place of service beyond the acute setting,” says Andrea Logan, president, AllMed Medical. That includes extended care, post-hospital rehabilitation, telemedicine and home healthcare, she points out. “I would also include the senior market, including assisted and independent living. Care is migrating into these areas.
“The expansion of place of service is the most obvious change,” Logan continues. “Coordination of care throughout the continuum is evolving and will continue to see changes as we see greater communication among hospitals, ACOs, rehabilitation centers, home healthcare givers and other post-hospital settings.” It’s becoming increasingly common for nursing homes to assign care coordinators, whose job it is to ensure medication reminders, the right products and technology, etc. are in place, and that patients are efficiently moved through the system, she adds.
“From a reimbursement perspective, managed care and alternative payment models will prevail,” Logan says. The traditional fee-for-service model will be very limited. Acute providers and insurers will drive the care coordination and demand outcomes from affiliated providers. Consolidation and preferred provider networks will also be the norm, with a focus on wellness and disease-state management.”
As patients leave hospitals sooner, but aren’t well enough to live on their own, “where do you place them?” asks Eric Cohen, vice president of business development, McKesson Medical-Surgical. Much depends on the patient demographics, including the patient’s age and level of wellness, he points out. And, “it involves moving the patient through a continuum of care to provide the necessary care at the lowest level of cost. So, for example, a patient will be moved from the hospital to a post-acute-care center to home healthcare.”
“The traditional long-term-care (LTC) or skilled nursing facility (SNF) patient needed help with such tasks as bathing and taking medications,” Cohen continues. “But, as hospitals discharge patients sooner, the acuity level is rising in the traditional SNF, and they are now becoming a more step-down or post-acute center.” Whereas years ago LTC and SNF patients often were elderly, today it’s common to see 40-, 50- and 60-year-olds in these facilities. And, not surprisingly, more and more are changing their signs to read ‘Post acute care center,’” he adds.
A new definition
The term post-acute care has come to refer to any care that is provided to an individual after a stay in the acute-care hospital, according to Kim Barrows, RN, BSN, president of KB Post Acute Strategic Specialist and a consultant for Abbott. This includes, residential care facilities, skilled nursing facilities, long-term acute-care facilities, home health, outpatient therapy, telemedicine, wellness classes and ongoing education, she says. “These services are provided to enhance and reinforce an individual’s ability to go home and idealistically stay home. Post-acute care is like the median: The individual is not sick enough to stay in the hospital, yet not well enough to be at home safely without the services provided by a professional or paraprofessional.
“Historically, nearly everyone was referred to a long-term care/skilled nursing facility following a hospital stay,” Barrows continues. “Recent years have shown that post-acute care more times than not involves sending a patient directly home [and] bypassing the LTC/SNF setting, thereby increasing the demand for home health services. Post-acute care offers various services that support an individual’s recovery from an acute illness or surgery, or to assist them in managing a chronic illness or disability.”
The post-acute-care environment is providing care to more complex patients in both the SNF and in the home health setting, notes Barrows. “These individuals are discharged from the hospital sicker and require a continuum of complex care model (i.e., wound care/IV therapy, etc.). Post- acute-care providers face as much of a challenge in providing care to these individuals as their professional peers in an acute-care setting. Post-acute care has also evolved by branching out into individualized care areas, such as behavioral health, out-patient clinics, palliative care, home health agencies, hospice, outpatient rehab services, sub-acute-care units and telemedicine,” she adds.
Providing value
It’s important that sales reps understand exactly how the long-term care/post-acute care market is changing, notes Cohen. “The patients, products and environment – including how your customers get paid – are all changing.” It’s not only that the market is changing, he adds. “Long-term-care and skilled-nursing facilities are under more pressure than ever before to provide better quality patient care, in a shorter amount of time. And, by the way, you’d better not send them back to the hospital! (“Avoidable readmissions,” he points out.)
“This is a highly regulated environment,” Cohen continues. “These facilities can get cited if the food is too hot for the residents!” (The state looks at these types of things during surveys, as elderly people often lose their sense of hot and cold.) Citations can bring down a facility’s rating, and “a one- or two-star facility will never make it in this new environment we are moving into,” he says. “If sales reps don’t understand this new environment their customer is in, how can they go in and provide value?”
Products and technology
Changes in the market imply the need for new and better technology. Telemonitoring, telehealth, point-of-care testing and more complex diagnostic equipment will all play a role in the evolving post-acute-care environment, notes Logan. “There is a difference between telemonitoring and telehealth,” she adds. “Telemonitoring refers to remotely monitoring patients with chronic diseases, [as well as] blood pressure, pulse oximetry, weight and blood glucose, allowing providers to be more proactive and potentially prevent an unnecessary hospitalization.
“Consumers must have the ability to obtain access to today’s modern technological devices used to monitor their health and wellness, as well as receive education on how to use these available tools,” says Barrows. “This may include computers, cellphones, tablets and monitoring devices. They will also need access to transportation to get to follow-up doctor appointments, [as well as] access to food, supplies, medications and wellness screenings. These key products will be vital to [patients’] successful recovery.
“The post-acute-care industry is a vital component of the evolving healthcare environment,” Barrows continues. “According to the U.S. Census Bureau, by 2050, [the number of people] over the age of 65 will double, and [the number of people] over the age of 85 will triple, thus increasing the need for post-acute care services. At the same time, the Centers for Medicare & Medicaid Services is working diligently to encompass a new payment model based on quality. Due to the penalties of unnecessary hospital readmissions, post -acute care is a key partner in ensuring successful clinical and financial outcomes.”
Now more than ever before, sales reps need to stay current on healthcare changes and updated on the latest technology and medical advances in disease management, early detection and prevention, notes Barrows. “Your customers are going to expect more from their vendors than just a good product at a fair price.”