Preferred Post Acute Providers

While progressive hospitals and health systems began forming preferred post acute provider lists to improve the care continuum several years ago, it is on its way to become the norm across the country. It reflects the hospital's coordinated effort to reduce the number of skilled nursing facilities and home health companies it partners with,while gathering ongoing outcomes used to educate and improve partner-dependent outcomes.

The community hospital has always been the center of healthcare services. But as the healthcare industry migrates toward a value based environment, keeping people out of the hospital and avoiding re-hospitalizations have become targets of new delivery of care models.  From ACOs to hospitals at home to medical homes, there is a growing recognition that if patients can be safely and effectively treated outside of the acute care facility, there is less risk and less cost. 

But there are situations where hospital care is essential:  Some severe surgical procedures typically require acute hospitalizations as do severe exacerbations or a new onset of a serious medical illness.  The time spent in the acute care phase however, is dwindling down to the precious few and having surmounted the time in the hospital, the real risks for the patient lay ahead.  Whether in the home, or another healthcare facility, the immediate aftermath of a hospitalization exposes the patient to some serious threats.

Traditionally, aside from making post-acute care arrangements, hospital leaders bear no responsibility for aftercare. As soon as the patients no longer require acute care, nurses prepare them for discharge, medications are reviewed, and the patient’s nurse makes sure the patient has a ride home.  But that’s all changing with the expected growth of bundled payments.

Under bundling, excessive or poorly coordinated aftercare may expose the hospital to payment penalties, low patient satisfaction scores, reimbursement short-falls, and poor clinical outcomes. Data have demonstrated that post-acute services, such as rehab or SNF care, physician services or home health generate the majority of costs.  Scheduling and coordinating these services are often huge challenges best left to the experts in the hospital’s Post Acute Resource Center.  In addition, the flood of medications prescribed for the patient plus the medications sitting on the kitchen table at home, pose their own set of risks and potential harm.

Bundling models are designed to make post-acute affiliations an imperative.  The affiliations may be formerly codified through acquisition or contract or it may be a neighborly relationship.  But to lay the groundwork for smooth transitions of care, consider these 5 steps:

1. Set up a site meeting at each post-acute care (PAC) facility in your community. Include senior medical and administrative leadership from both the hospital and the facility.  Present the hospital’s business and clinical objectives and, in turn, attain a solid understanding of the facility’s business model.  Schedule these meetings semi-annually and hold individuals accountable for following up any issues identified.  Set up similar meetings with home-care or DME service providers.  
2. Prior to discharge, make sure that the clinical pharmacist or the attending physician reviews the patients’ medication regimen and clearly indicate which medications are to be continued post hospitalization. Recently discharged patients are especially vulnerable to polypharmacy unless it’s made very clear that the medication list confirmed by the discharging physician is the totality of the medications the patients should be taking.  It is in the physicians’ and the patients’ best interest to address this issue, as readmissions due to adverse drug events and polypharmacy are avoidable.
3. Study the pattern of patient referrals between the hospital and each PAC service provider in your area. Keep track of how many patients the hospital sends to and receives from each provider and get down to the details of who is making those referrals and the supporting documentation for those decisions. Seek assurance that decision on patient referrals are solidly grounded in evidence-based care and not on the basis of personal relationships or provider ownership.  
4. For each PAC provider in the community, select a hospitalist, a nurse or a care manager to serve as liaison.  The liaison should get to know the administrative and medical leadership of the facility, round on a regular basis, and provide feedback to the facility’s team when necessary.
5. Set up an evaluation system for each PAC provider.  Create a series of key metrics by which each provider can be graded.  For example, the staff in the PARC (post acute resource center) can maintain a list all the skilled nursing facilities in its catchment area.  The liaisons can grade each PAC facility based on the condition of the facility, timeliness of access to medical care, readmissions (with reasons why), and other factors as identified.   Share these evaluations with all the PAC providers as well as with patient care teams.

Despite the recent 'hold' on Medicare sponsored bundle payments, commercial payers are still moving toward this efficient payment model. Under the model,  hospital leaders are becoming increasingly accountable for the quality of care delivered to their patients at all points along the care continuum – before hospital admission (or readmission), during hospital stays and after hospital discharge.  Engagement between the hospital’s resources and the PAC provider will be a necessity to build a care management structure across the continuum and to lay the groundwork for a population health management program in the community.