Shifting resident needs and value-based care models have significantly changed the landscape of post-acute care.
By Jenna Hughes
The post-acute patient experience is changing. Indeed, patients’ needs within long-term care (LTC), skilled nursing facilities, home health, and inpatient rehabilitation facilities are shifting toward a focus on patients’ whole health and individual outcomes over volume of care.
LTC residents’ needs are being met through an emphasis on interdisciplinary approaches to chronic disease management, personalized patient care plans, and coordinated care across multiple healthcare settings.
“Our patients in PALTC (Post Acute and Long-Term Care) are older, sicker, and frailer compared to patients we used to see 15-20 years ago,” said Dr. Rajeev Kumar, President of AMDA – The Society for Post-Acute and Long-Term Care Medicine. “The aging of our population in addition to changes in healthcare payments due to evolution of Fee for Service (FFS) models of care into Value Based Care (VBC) has empowered clinicians and nursing staff to operate at the top of their licensure to care for this high-risk patient population.”
Post-acute care residents are staying in facilities for shorter periods of time and technology is allowing patients to be treated through at-home care, while the shift to value over volume within healthcare has revolutionized the industry, providing a greater focus on patient outcomes.
Distinct patient populations
The proportion of the U.S. population seeking care in nursing homes has climbed higher due to an aging population, longer life expectancies, and a lack of alternative care facilities, according to the National Library of Medicine study, “Evolution and Landscape of Nursing Home Care in the United States.”
Older adults are increasingly seeking care outside the hospital and in long-term settings such as short-term nursing home stays, assisted living, and at-home. As a result, nursing homes have begun to admit residents with more acute nursing needs.
“Both facilities and clinical practitioners are held accountable for patient outcomes and Medicare spend under Value Based Care,” said Dr. Kumar. “Therefore, our patients are increasingly treated in place whenever possible and are transitioned to their homes (lowest care settings) as quickly and efficiently as possible.”
Nursing home residents now comprise two distinct patient populations: post-acute patients, (who typically are admitted after a hospital stay) and represent 43% of the nursing home population, and longer-term residents (requiring care for chronic medical conditions and/or assistance with activities of daily living) represent 57% of the patient population, according to the National Library of Medicine. The average length of stay for a long-term resident is 2.3 years, compared to 28 days for short-term stay patients.
Prolonged stays in acute care increase the risk of hospital-acquired infections and disrupt patient flow and access to care due to bed shortages. However, as shorter stays within post-acute care facilities rise, patients are spending less time overall in healthcare settings as a result of quicker recovery times, improved care coordination, and more efficient rehabilitation.
Reimaging the long-term care setting
Nursing homes and long-term care facilities often double as a place of residence for many patients while they are undergoing treatment. Recently, the healthcare industry and its stakeholders began to recognize the need to balance the delivery of clinical care with patient’s quality of life. This shift has revolutionized how post-acute care is delivered, making long-term healthcare facilities focused more on each patient as an individual, according to the National Library of Medicine.
“To meet resident’s evolving needs, physicians and Advanced Practice Providers (APPs) are using telemedicine and RPM to tend to and remotely assess patients 24/7, to anticipate and intervene when there are changes in condition, and to timely and appropriately treat patients and prevent adverse events including hospitalizations,” said Dr. Kumar.
Value-based care has additionally led to a culture change in nursing homes, with residents’ choices being prioritized to enhance quality of life.
“Social workers, psychologists and psychiatric practitioners are more readily available in PALTC to address mental health needs, especially with the evolution of patient care models to cater to a sicker, more frail patient population,” said Dr. Kumar.
The need for ensuring patients’ quality of life in LTC became evident during the COVID-19 pandemic, which had a significant impact on nursing home care, residents, and staff. The virus that causes COVID-19 (SARS-CoV-2) is particularly dangerous for older adults with underlying health issues, and long-term care residents, as a result, suffered disproportionately high rates of cases, hospitalizations, and deaths relative to the general population, according to the National Library of Medicine. The pandemic shed light on the need for a more balanced approach to care in post-acute care facilities.
“All staff members within long-term care must be involved in monitoring patients’ emotional health and supporting them through times of transition,” said Dr. Kumar.
Value over volume and patient outcomes
Across the healthcare industry, health systems and hospitals are seeing a shift from fee-for-service care to a focus on the value of patient outcomes.
Value in healthcare is a measure of a patient’s health outcomes compared to the cost of achieving that improvement. According to Forbes, stakeholders within the healthcare industry are increasingly accommodating the aging population to make care both more effective and efficient for LTC residents.
“PALTC facilities need to continue to ramp up their capabilities to provide hospital level care, adopt innovative models of care, such as telemedicine and remote monitoring, and train staff to operate at the top of their licensure to care for an increasingly complex patient population,” said Dr. Kumar.
Medicare’s Patient-Driven Payment Model (PDPM) for skilled nursing facilities (SNFs) was implemented in October 2019 to shift reimbursement within long-term care from a system based on volume of therapies provided to one based on patients’ clinical conditions, needs and characteristics, according to Forbes.
The Centers for Medicare and Medicaid Services also implemented similar models in other post-acute settings. CMS implemented the Patient-Driven Grouping Model in home health in January 2020, rolling out value-based purchasing (VBP) models across the post-acute sector to link payments and performance to hospital readmission rates and other key measures.
Acute care facilities are continuing to be incentivized to move their patients to lower-cost, clinically appropriate care settings to free space and hospital beds.
Additionally, a greater focus has shifted to post-acute care providers as important clinical collaborators within healthcare that have the ability to reduce preventable hospital re-admissions and ensure the health and well-being of LTC patients with complex needs.
“Telehealth, Remote Patient Monitoring, and the increased onsite availability of clinical practitioners with the increasing numbers of APPs in PALTC have helped us move in the direction of value-based care,” said Dr. Kumar. “Our organization advocates on behalf of our practitioners, patients and all of our PALTC communities to bring about policy changes to improve post-acute and long-term care systems and processes.”