Why Hospital Readmissions from Nursing Homes Don’t Matter
The Senate recently passed a bill that links skilled nursing facility payments to hospital readmissions. Despite this, hospital readmissions from the nursing home will not change the way they operate. This bill is nothing more than a rate reduction bill for nursing homes.
In nursing homes, occupancy is King. From the birth of the nursing home industry, owners and operators of nursing homes have (mistakenly) considered physicians to be their leader of admissions for their facilities. Thus, owner/operators would do nothing to upset physicians for fear that admission retribution/reduction would result.
While this misperception may have been true in the 1960s, it is certainly not true in 2014. Within the modern era of healthcare, ACOs (Accountable Care Organizations), MCOs (Managed Care Organizations), Hospitalists, Case Managers, Discharge Planners, etc., these entities now control the flow of patients to nursing homes, NOT physicians. These new entities are the new generals of the army of healthcare while the physician, in regards to admissions are but a mere foot soldier.
Does this mean that the role of physicians has diminished to become insignificant? Of course not! Physicians have the greatest influence over quality of care including the avoidance of hospital readmissions.
So, while vintage operators will maintain fifty-year-old hopes and endure the hum drum nonchalance of older physicians sending patients to the hospitals every time a nurse calls them, progressive and defensive operators will adopt an organized Post Hospitalist Program within their facilities to improve quality, reduce readmissions and attract admissions from the modern leaders of admissions: ACOs, MCOs, Hospitalists, etc.
Hospital Readmission rates are 50% below the national average; Quality Metrics are in the top 10% nationally; Four and five star ratings by CMS; Recognition as being “Best Nursing Homes in America” by the U.S. News and World Report. All of these are the actual results hundreds of facilities across the United States have achieved utilizing a Post-Hospitalist Program.
OK, so what are Post-Hospitalist Programs and Post-Hospitalist Medical Services?
A Post Hospitalist Program is a recognized, specialized approach to the practice of medicine in post-acute and long-term care settings.
As hospitalists provide specialized care to hospitalized patients, Post Hospitalist Programs provide specialized medical care to patients residing in facilities such as: LTACs; Sub-Acute Centers; Hospital SNU Units; Skilled Nursing and Long-term Care Facilities; Rehabilitation Centers; Residential and Assisted Living Facilities.
The specific types of medical services provided usually include: Attending Physician Services, Nurse Practitioner and Medical Director Services. Generally these services are provided by a collaborative group practice of Physicians and Advanced Nurse Practitioners that specialize in providing “On-Site” Medical Services to patients residing in these various types of facility settings.
In recent years, acuity levels and medical needs of most patients entering post-acute and long-term care facilities have dramatically increased. At the same time, physicians attempting to care for these patients just didn’t have the time or resources to effectively manage these greater needs.
As a result, physician oversight and resident care suffered, or worse yet, patients are sent out to ERs or admitted/readmitted to hospitals at significant risk to the patient, and much greater costs for their care.
To fill this void in healthcare delivery, Post Hospitalist Medicine evolved to fill the need for greater oversight; improved processes for transitioning between levels of care; improved patient health outcomes; reduced hospital lengths of stay; reduced frequencies of potentially avoidable hospitalizations and readmissions; and ultimately, to reduce overall health care spending.
OVERALL GOAL OF POST-HOSPITALIST MEDICINE
Enhance and Coordinate the Care of Patients in Post-Acute and Long-Term Care Settings
- Improve Patient Health Outcomes.
- Improve the Process of Transitioning between Care Levels > Inpatient Hospitals, Post-Acute Facilities and Other Settings.
- Reduce Hospital Lengths of Stay.
- Reduce the Frequency of Potentially Avoidable Hospital (PAH) Admissions and Readmissions.
- Reduce Unnecessary ER Utilization.
- Reduce Overall Health Care Spending.
In order for today’s progressive and successful nursing home operator to really make a difference, stand out above the crowd and achieve the possibilities needed for today’s new healthcare paradigm it is essential for them to adopt a Post Hospitalist Program in their facility.