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Senior Housing > Blog > 2014 > September

Skilled Nursing Facility Providers Need Thick Skins and Deep Pockets.

Skilled Nursing Facilities often are charged with premature death of residents, questionable quality of care, fraud, waste and abuse.  Such charges may be legitimate, but also can be from an overly protective family member or a disgruntled employee.  The problem is, whatever the charge is whether legitimate or illegitimate, the cost is high and quality of care suffers.  Los Angeles County auditors have found problems with the way the public health department investigates nursing home complaints involving issues of safety, neglect and other problems that could jeopardize the well-being of residents.

According to a Los Angeles County audit report, issued citations were downgraded by the public health department supervisors without notification to the county resulting in the impairment of quality and integrity of the investigations.  However in defense of their downgrading of citations, the public health department sited its desperate need for more funding from the State for additional staff and resources.  Also the public health officials claim they have implemented numerous operational and administrative changes that have improved the program. 

Efforts to improve the program of the public health department, of course is a step in the right direction, but a “baby step” to an overwhelming problem.  The county is responsible for 2500 health facilities, including nursing homes, acute-care hospitals and hospices.  A previous county audit complete in April found a backlog of 945 nursing home investigations that had been open for more than two years!  In many cases investigations were actually closed before they were completed.  The consequence is that nursing homes throughout the county hardly ever face any consequences, even when the public health department detects neglect or abuse. 

Skilled Nursing Facilities as well as all types of Healthcare facilities including Alzheimer, Assisted Living, Independent Living and Continuing Care Residential Community face the problem of complaints and citations.  It “goes with the territory”.   A dedicated, caring provider rolls with the punches and tries to improve their operation with their eye on the culture change in the industry, employing a person-centered, quality of care operation.   In cases where reimbursement is delayed or even eliminated, the provider must have a cash reserve in order to survive.  The increase in Skilled Nursing Bankruptcy filings reflects the absence of necessary funds to carry on when reimbursements are overdue or denied.

The U.S. Department of Health and Human Services and the Office of Inspector General recently published its Strategic Plan for 2014 to fight fraud, waste, and abuse, promote quality, safety and value, and secure the future, and advance excellence and innovation.  Another step in the right direction, and furthermore, we always like to end our blogs with a positive thought.

Skilled Nursing & Hospitals Hold Hands, a Win-Win Relationship

The Skilled Nursing and Rehabilitation market is in the midst of a transformation and faces a new world of accountability and readmission penalties.  There is a long overdue interest and awareness that nursing home providers provide the key that can reduce unnecessary hospitalizations which trigger financial penalties for both the Skilled Nursing provider and the Hospital.  With the realization that private and public payers are committed to VALUE BASED HEALTH CARE, the days are over when financial success was tied to the census of a hospital or a skilled nursing facility.  

THE HOLDING HANDS RELATIONSHIP is new and demands cooperation from both hospital and skilled nursing provider.  Both share the goal of avoiding unnecessary inpatient stays, but a hospital’s facility, protocols and standards are very different from those of a SNF.  Furthermore, the communication gap between the two providers is great.  Nursing homes frequently do not receive the information they need to properly care for patients discharged from the Hospital.  Although there are many programs that address the problems of the marriage of Hospital and Skilled Nursing Facilities, the financial incentive to change to valued based health in the short term view, is not as important to a skilled nursing provider as it is for the hospital.   Cut in reimbursement rates for readmission are significant for hospitals, not for all skilled nursing facilities yet, but the handwriting is on the wall.

THE GOOD NEWS IS the skilled nursing provider doesn’t get off the hook, which is a tribute to the fact that the healthcare industry is “growing up” and adjusting to the demands of the culture.  For example, a good many health systems are creating a network of SNF’s that agree to meet quality standards, share data, provide certain services and work with hospitals to reduce, avoidable hospitalizations.  Upon discharge from a hospital, a patient is given the list of approved skilled nursing facilities that have met the Hospitals requirements and are included in their network.  Of course the patient can choose any nursing facility, but hospitals can help patients make good choices.  If a skilled nursing facility becomes a preferred provider they enjoy increased census and increased revenue.  In the long term when unnecessary hospital readmission from nursing homes reduces their reimbursement rate, the skilled nursing will survive that has developed a value based health care plan.  The ones that do not meet the new higher standards will not survive or end up in the bankruptcy court.

AND SO THE BEAT GOES ON!  The result of all the effort by various organizations like the Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation is resulting in the   integration of hospital and acute care providers.  The result is lower costs and improvement in the quality of care.  The entire healthcare industry is becoming more sophisticated and in the big picture is making giant steps in achieving what is necessary to create a structure that will support the goals of Value based care as well as financial reward.