Post-Acute Lessons

By Mark Thill

“The long-term care industry is changing, and quickly,” wrote Senior Editor Laura Thill at the beginning of the year, when Repertoire launched its post-acute-care section. “As the market evolves into a post-acute-care environment, it’s essential that sales reps understand how this impacts their customers.” That has been our mission this year, and will continue to be our mission in 2017.

We began the year defining what we mean by the term “post-acute care.” Andrea Logan, president, AllMed Medical, helped us out.

“We define ‘post-acute’ as any place of service beyond the acute setting,” she said. That includes extended care, post-hospital rehabilitation, telemedicine and home healthcare. “I would also include the senior market, including assisted and independent living. Care is migrating into these areas.”

Since then, Andrea Logan and many others have taught us at Repertoire much about post-acute care. And no doubt they will continue to do so in the years ahead. We will keep passing that knowledge on to our readers. Meanwhile, here’s just a little of what we learned in the past 12 months.

Expansion

• “The expansion of place of service is the most obvious change. 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.”
  – Andrea Logan, president, AllMed Medical

• “From a reimbursement perspective, managed care and alternative payment models will prevail. 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.”
  – Andrea Logan

Acuity

• “The traditional long-term-care or skilled-nursing-facility patient needed help with such tasks as bathing and taking medications. 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.’”
  – Eric Cohen, vice president of development, McKesson Medical-Surgical

• “This is a highly regulated environment. These facilities can get cited if the food is too hot for the residents. [A] one- or two-star facility will never make it in this new environment we are moving into. If sales reps don’t understand this new environment their customer is in, how can they go in and provide value?”
  – Eric Cohen

Bypass

• “Historically, nearly everyone was referred to a long-term care/skilled nursing facility following a hospital stay. 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.”
  –Kim Barrows, KB Post Acute Strategic Specialists

Value-based payment

• “It is important that all providers understand that value-based payment models, including bundled payments, are continuing to roll out across the nation.”
  – Lisa Thomson, chief marketing and strategy officer, Pathway Health

• “If a provider can demonstrate performance outcomes, quality care experience and a positive patient experience, the opportunities are endless in the new payment models. Post-acute-care providers need to re-imagine and redesign care delivery and processes to align with the new quality expectations and payment redesign.”
  – Lisa Thomson

No escaping the market shifts

• “2016 will represent some big market shifts. If you’ve been tuning out the noise, you can no longer do so.”
  – Andrew E. Van Ostrand, vice president, Care Continuum/Extended Care, Medtronic

Choose your partners wisely

• “For several years now, hospitals have been choosing their post-acute care partners and providers wisely, due to the financial consequences of readmissions within 30 days with certain diagnoses.”
  – Susan LaGrange, RN, BSN, NHA, CDONA, CIMT, director of education, Pathway Health

• “There may continue to be opportunities in this area on both sides – that of the hospital to ensure stability of the resident’s condition for discharge with good communication, and that of the post-acute care facility to prepare with a good pre-admission assessment process for a successful care transition.”
  – Susan LaGrange

Post-discharge planning?

• “The challenge is, there is a lot of variation among hospitals and discharge planners as to how a post-discharge plan is determined. If it’s a surgical case, the surgeon is involved. If it’s a medically complex patient, a hospitalist might be involved. Physician alignment is important, but who that physician is varies by patient. Decisions are based more on practice patterns than clinical effectiveness.”
  – Clay Richards, CEO of naviHealth, a Cardinal Health company

• “Historically, there has been no financial incentive for the hospital to manage the patient after discharge. But you’ve started to see that change, because of value-based purchasing, readmissions penalties and, more important, bundled payment arrangements.”
  – Clay Richards

Going home

• “There are all kinds of new technologies and innovation that are allowing care to be delivered in the patient home effectively. That’s why CMS is incentivizing people to move care in that direction.”
  – Joan Eliasek, president, extended care sales, McKesson Medical-Surgical

 

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Must-dos for bundled payment

All providers participating in the bundled payment program must ensure the following, says Lisa Thomson, chief marketing and strategy officer, Pathway Health:

• Safe and coordinated care transitions across provider types
• Agreed-upon clinical pathways across provider types
• Coordinated care
• Standardized performance metrics
• Data tracking
• Reconciliation of data to align with incentive payments
• Base payment
• Cost control
• Collaboration of services and supplies
• Financial risk adjustments, limits and outliers beyond the provider’s control

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Mission: Reducing readmissions

Post-acute-care facilities that closely consider “the culture of the readmission process, from admission through discharge, and collaborate with all entities the facility works with, as well as in-house systems” will be most likely to successfully limit hospital readmissions, says Susan LaGrange, RN, BSN, NHA, CDONA, CIMT, Pathway Health. This will entail the following:

• Communication. Staying in touch with the acute-care provider is crucial to ensure that the resident is appropriate for discharge to the post-acute care setting and that the proper care and resources are ready for the admission.
• Organization. The organizational process and systems management in the organization are essential to be able to identify early changes of condition and a streamlined approach to the evaluation/assessment, communication and care management in the facility.
• Education and training. Nurses require training on the assessment process, disease management and system processes for quality of care.
• Planning. Successful discharge planning should start on the day of admission.
• Follow-up. It’s important to follow up on discharged patients to ensure the successful transition of care and assistance with management in a new setting.

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Hot and cold

What’s hot in post-acute care?

• Population health
• Care coordinators
• Alternative payment models
• Avoidable readmissions
• Tele-everything
• Centenarians
• Interoperability
• Consultative selling

What’s not?

• Siloes
• Fee-for-service
• Transactional selling