The Post-Acute Care Combine: Impressing the Scouts
Author: Chris Murphy
Fee-for-service health care has created a culture of competition for hospital discharges among post-acute care providers of all types. As payment systems begin to reward quality and efficiency, post-acute care providers must change their culture to survive. Successful post-acute care providers will be those that differentiate themselves in the context of their work: helping patients transition from an acute care setting to a home or intermediate care setting quickly without bouncing back to acute care.
The problem is that differentiation is complicated by the need to remain fiscally viable under the current payment system, which encourages very different behavior. Identifying partners for the new health care reminds me of the NFL Scouting Combine: Youe’ll be evaluated on a broad skill set, and it’s important to have the right skills for your position. Here’s a strategy for impressing the scouts.
Patient Flow Is a 40-Yard Dash
Nursing centers must be able to demonstrate and educate potential network partners on programs to keep patient flow moving in the right direction and efficiently—from physician encounter to acute care to post-acute care to home or intermediate care.
- Quality starts at admission – The transition from acute care to post-acute care is the most difficult and risky in a patient’s spell of illness, especially if not done well. Scouts will look for partners with a well-defined admission process, including a fast-track process for patients within that center’s specialty. The admission process will include a “warm handoff,” where caregivers from both the hospital and post-acute care provider discuss the patient’s needs and health information required in the exchange.
- Know when the patient is making a U-turn – A desirable network affiliate will have a program in place to quickly identify changes in a patient’s condition and intervene timely. One such program is Interventions to Reduce Acute Care Transfers (INTERACT), which is publicly available.
- Have the right personnel at the right time – The nursing center must have strong, confidence-inspiring staff present and visible in the center at all times, but especially on Fridays and weekends. Acute care providers are struggling to discharge patients on these days; lack of confidence in weekend nursing center staff often is cited as a frequent cause of acute care readmissions.
Measuring Patient Care – Both a Vertical & Broad Jump
Acute care scouts are looking for great clinical programs. The fewer post-acute care providers in the network, the more efficiently the network can manage care and measure outcomes. A successful post-acute care provider will have a relatively broad set of effective clinical programs. It’s not that successful nursing centers must be willing and able to take every type of case; rather, by sharing information with acute care providers, they can develop programs around cases frequently seen in their communities. In other words, figure out the right breadth of service based on what the acute care providers and physicians need from you as a provider. The smart money is on programs that are more clinical or medical in nature, not based on rehab.
But it’s not enough to develop those programs. Length of stay (cost) must be balanced with outcomes. So your programs must be broad enough to meet the community’s needs and to provide high-quality, efficient and effective care to patients.
Heavy Lifting – Analyzing the Same Data
Not all nursing centers have systems to capture, integrate and analyze financial and clinical data. A successful partner will have good information about care delivery and the ability to use that information to improve patient care and efficiency as well as demonstrate the existing programs’ performance. To impress the scouts, a nursing center should be able to:
- Generate significant analysis on individual patients—expected profit or loss at preadmission, actual profit and loss after discharge, progress toward goals and patient retention post skilled discharge
- Track patients not admitted and the reason; this information will be instructive as you seek to broaden clinical programs
- Aggregate patient data that tells you, for a particular diagnosis or condition, the revenue and cost of care, length of stay, outcome, type of discharge, etc. This will be crucial in both contracting directly with hospitals and payors—you must know the cost to negotiate contracts—as well as in telling your story under bundled payments for purposes of network building.
Preparing for the Draft
Scouts often don’t have the time or expertise to evaluate potential partners on all the key metrics and adequately evaluate them based on the correct metrics. However, by implementing the suggested programs focusing on patient and acute care provider needs (and having the data to back up your story), you’ll be better positioned to land a spot on the team. Here are the steps to take now:
- Implement a program (INTERACT is a good one) to reduce readmissions—keeping residents after acute care discharge is good for relationships with hospitals and for the bottom line
- Gather information on needed specialties and clinical competencies; discuss with hospital case managers and review publicly available information to identify needed specialties
- Perform a skills inventory of clinical staff to uncover hidden expertise and identify needs matching community needs
- Start gathering data on each admitted patient; it’s a key to effective specialty development and supporting your story for the scouts
For assistance implementing programs to prepare for the new health care, contact your BKD advisor.