How Long-Term Care Providers Increase Hospital Referrals

Carol Marak is a contributor for the senior living and health care market. She advocates for older adults and family caregivers by writing on tough topics like chronic issues, senior care and housing. Find Carol's work at www.assistedlivingfacilities.org and contact her at Carebuzz@gmail.com.

Skilled-nursing, assisted living and home care providers often ask, “How do we design offerings to best fit patients’ needs that will boost hospital referrals?”

A few long-term care providers, like Eskaton, are ahead of the game in gaining close ties to acute care providers. They learned what it takes to build a strategy that embraces care management, training, and prevention and wellness—the types of skills that hospitals look for in order to reduce unnecessary hospitalizations.

Sheri Peifer, executive at Eskaton says, “It’s because of our former hospital-based healthcare background in 1980 that set us up to easily transition to working with ACOs and hospitals. We knew the challenges they faced with the 30 day readmission penalties and we had to figure out what it meant to be an ACO, and learn its moving parts so that Eskaton could build a strategy to complement a hospital’s offerings.”

So, Eskaton put in place the offerings needed to help patients transition more quickly out of a high cost acute care facility into a lower cost setting. They made it their goal to work with health care systems and to pick up the ball where they fell short. That’s why they added more care management personnel, along with wellness nurses and prevention programs.

Gone are the days when financial success was tied to a hospital's inpatient census. Today, the private and public payers are committed to value-based health care, which means patients must be treated in the lower cost and suitable setting.

Other approaches were added to improve value, like bundled payments, incentives to keep patients out of inpatient beds, and wellness and prevention programs that prolong better health. 

How Post-Acute Care Aligns With Health Care Systems

Working with ACOs takes specialized knowledge of managing chronic illnesses, care coordination, wellness, and prevention. It also takes a willingness to learn transitional care strategies.

The hospitals look for post-acute care providers who want to partner with them and who want to fully support their clinically integrated health system and delivery of care.

The skilled nursing industry is better equipped to handle these transitions from costly acute care settings to a nursing home facility. Yet, a nursing home’s protocols and standards are different from those of a hospital.

It’s important for skilled nursing facilities to meet quality standards, share data, provide certain services and work with hospitals to reduce avoidable hospitalizations. The nursing care facility must be positioned to handle an adequate capacity, high quality, geographic coverage, special services and the willingness to accept hard-to-place patients.

Assisted living facilities may have more difficulty partnering with hospitals. In 2010, CDC conducted a study of 2,200 plus residential care facilities nationwide. It found only 25% offer short-term care services.

39% of the residential care facilities provide skilled nursing services. Of those, 46% hire skilled nursing personnel in-house, while 54% contract the services.

40% of residential care facilities offer occupational therapy, but only 14% of the therapists are employees of the facility.

44% of the Residential Care Facilities provide physical therapy for residents, but only 17% of the people performing physical therapy are employees of the facility

96% of the care facilities offer basic health monitoring, such as blood pressure and weight checks and 85% of the facilities' that provide health monitoring use staff to perform these checks.

57% of facilities provide case management services.

87% of the facilities that provide special diets are served by paid facility employees.

What's In It for Long-Term Care Providers?

If you’re seeking close ties with hospital discharge teams, an assisted living facility must go beyond the basic health care and activities of daily living.

Ms. Peifer says, “Eskaton started with adding more short-term skilled beds to illustrate their overall commitment to the transitional care model.” Other types of services Eskaton added to increase hospital referrals:

Go beyond the top three chronic illnesses and add health care services that apply to controlling infections, preventing pressure ulcers, palliative care, wound care, insulin therapy, pain management, and clinical care management. 

In the near future, CMS will expand to prevention and care coordination, that’s why Eskaton has integrated wellness nurses, prevention programs, and proactive house calls into their assisted living and home care programs.

The key is to get ahead of the system.

Build a network and sponsor quality meetings with discharge planners to communicate your specialized care offerings.

Get a clear understanding of the financial penalties that hospitals face having high readmission, and then show how your specialized services can help them cut risks.

Become a partner with health care systems and offer short-stay, long-term and specialized care. Create new programs that target hospital-led initiatives and introduce services to gain liking with payers and providers alike.

Start a care transition program to follow the patient for 30 days after discharge from your facility. The goal is to make sure the patient takes medications appropriately, connects with the medical team when needed, and accesses home health and other health care services to help avoid a hospital readmission.

Have a 24/7 centralized admission office, one that’s headed up by resource coordinators and care managers who give full patient assessments prior to discharge.

It’s important to figure out what illnesses you can treat instead of at the hospital. It may be an advantage to hire a nurse practitioner or a physician.

How High-Tech Is Your Facility?

It’s important to healthcare systems that a post-acute provider has the ability to access patient data from an electronic health record system, which helps with the transition from hospital to a post-acute facility.

CDC found that 37% of assisted living facilities have technology to measure demographic information. For the 63% who do not, the pressure is on to gather specific health data on residents.

Preparing assisted living facilities to deliver care coordination and remote care monitoring of chronic conditions help avoid movement of residents to higher levels of critical care.

Currently, electronic medical records measure four components (resident demographics, nursing assessments, problem and medication lists) in 17% of assisted living facilities.

Installing and maintaining technology is a costly investment. The for-profit communities have the financial infrastructure to adopt EMR earlier than non-profit ones. Policymakers believe that the adoption and subsequent use of EMRs are essential to improving the quality and efficiency of the U.S. healthcare system.

Overall, the goal of implementing EMR in the assisted living settings enable immediate, electronic access to a resident’s health record, which results in efficient, integrated care across healthcare settings.

Adding healthcare services and technology to one’s mix of offerings will help patients quickly recover and avoid heading back to the hospital.