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.