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Earning Back a Place at The Post-Acute Care Table

A previous blog post on this site talked about the post-acute care market, and how to earn back the business, but there is more to that challenge.

In 2017, Deloitte released a study entitled Viewing Post-Acute Care in a New Light: Strategies to Drive Value. The paper addressed what a lot of those in the SNF world already knew, post-acute care providers, and especially SNFs as those providers, are the industry’s best-kept secret.

Starting with the implementation of the Affordable Care Act in 2013, providers up and down the treatment continuum have experienced pressure to drive down costs and increase quality of healthcare. Moving patients to a post-acute-capable SNF was and still is an excellent way of maintaining that continuum of care but at a reduced cost.

“It is clear that we have an opportunity in terms of quality and cost [in post-acute care],” said one physician. “It’s [also] clear that we are not transitioning patients out of acute well.”

Another post-acute care executive said it even better, “I do not believe the goals of ACA can be achieved without a strong post-acute care industry.”

Yes, you heard it right: post-acute care providers are that important.

But Post-Acute Care Hit Another Speed Bump

Then came COVID and the need to free up hospital beds in acute care facilities. Post-acute was a way to accomplish that and attend to patient needs, too. At any other time, this would have been a boon to owner-operators in the SNF world, but SNFs were mired in their own COVID issues. Residents and families responded to the negative news reports of large numbers of COVID-related deaths at SNFs by finding another place for their post-acute care needs.

As noted in a 2021 paper by JAMDA, the Journal of Post-Acute and Long-Term Care Medicine, “The decline in SNF admissions may hasten a change in the role of nursing homes, causing nursing homes to focus more on long-term care as post-acute care admissions decline. This specialization in long-term care may benefit patients, but given the lower Medicaid reimbursement rates, may also cause nursing homes to become more financially unstable and, in the worst case, forcing some to close.”

As we transition out of the pandemic, SNFs have some catching up to do. In light of the COVID crisis among SNFs, long-term acute care hospitals (LTACHs) and in-patient rehabilitation facilities (IRFs) have claimed larger shares of the post-acute care patient census. Home health, always a popular option with physicians and patients, care has also expanded its share to a much greater degree.

The Post-Acute Care Market

Is the post-acute care market worth pursuing for SNFs? Yes. It represents tremendous expansion.

That market continues to grow, spurred on by the demographics of an increasing senior population. Hip and knee replacements, two procedures often in need of post-acute care, are almost a rite of passage for seniors and many younger patients. Chronic conditions such as heart disease remain at record highs. According to Deloitte, more than one in five patients (22%) discharged from a hospital receives post-acute care. McKnight’s Long-Term Care News reported in 2020 that facilities had experienced a 15% bump in post-acute-care-related business.

How Do Your SNFs Compare?

Particularly concerning SNFs, the study quotes numbers that are interesting to know and can be used as a baseline for comparing your facility:

  • Medicare spends 12% of its annual expenditure, or $60 billion, on post-acute care.

  • Variation in post-acute care accounts for 73% of Medicare’s annual variation spending (meaning that of all the unanticipated spending done by Medicare, 73% falls into the post-acute care category).

  • The top SNFs have an average length of stay of less than 24 days for post-acute care patients. Low-performing SNFs average 34 days.

  • The top 25% of SNFs have a 7.8% rate of avoidable readmissions. The lower 75% of SNFs have a readmission rate of 13.6%.

  • SNFs re-hospitalize 22.8 percent of their patients within 30 days.

Re-hospitalizations cannot be laid entirely at the door of SNFs. Consider this quote from a post-acute care physician executive: “Patients in SNFs today—these used to be hospital patients when I was in residency training.”

Earning Back That Place at the Post-Acute Care Table

Until the pandemic, home health options and SNFs received most post-acute care patients. How much that has changed post-pandemic is unknown. We do know, according a N.Y. Times article, that by Q4 of 2020, the overall occupancy rates of SNFs were down to 75%, a drop of 11 percentage points from Q1.

SNF’s need to develop their COVID protocols and organize them in a way that is easily presentable and interpreted, proving that they are taking all precautions to prevent outbreaks. SNFs must also realize that most health systems, as well as physicians, have a limited understanding of post-acute care and the capabilities of the different providers. It is not uncommon for patients to be assigned to an LTACH for their post-acute care, when a well-equipped SNF would provide the same level of care at a lower cost. Doctors don’t always know this.

Health plans have also come to recognize the importance of post-acute care and the need to match the patient with the right facility. Memorial Hermann, a health system serving southeast Texas, has gone as far as developing a software platform and providing an app for its physicians to communicate with post-acute facilities and their staff.

SNF and LTC operators need to investigate their service areas to determine if similar arrangements are being made within their medical community. These are efforts we all need to be involved in.

… And of Course, It Is Also About the Data

The Deloitte study also advocates for acute-care facilities to partner with members of the post-acute care industry. Networking and getting involved in your community is key. Find out who is shaping the healthcare landscape in your geographic area and become part of the process. Don’t wait for them to come to you.

One of the things Deloitte also recommends looking for is a facility that is committed to a “willingness to analyze their data to guide improvement.”

This is crucial. The future of health care will be in establishing partnerships between the various members of the industry. Companies that have a handle on their data, and can interpret the meanings, will be the more attractive partners.

CareWork Can Help

This, of course, is where CareWork excels. We provide a platform that ties all the various elements of a senior care facility: census, personnel, scheduling, outcomes, and more, and brings them together in one easy-to-interpret view. Leadership can make decisions based on data rather than by guesswork and gut feelings.

Visit our website and call us today.

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