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SNF Operator: 'Everybody is Stepping Up Their Game'

Analysis  |  By Christopher Cheney  
   October 10, 2016

With bundled payments and other lean value-based payment models spreading across the country, relationships between hospitals and post-acute-care organizations are tightening.

Market forces are driving closer collaboration between hospitals and their post-acute-care providers, says Audrey Weiner, president and CEO of The New Jewish Home.

"We have had an intensive level of collaboration for the past three years. Before that, we had a discharge planner who sent you patients. Now, it really is thinking about what is best for the patient, with feedback in both directions. The hospitals want the feedback, and the post-acute-care providers want the feedback. Everybody is stepping up their game," she says.

A pair of reports published last month reflect the daunting challenges facing the post-acute-care sector. The Journal of the American Medical Association published a research paper that concluded Medicare's bundled-payments program for hip and knee replacement has reduced spending mainly through lower spending on skilled nursing facility (SNF) services.


Getting the Value Out of Postacute Care


In a report based on data collected from 2011 to 2016, the Annapolis, MD-based National Investment Center for Seniors & Care (NIC) found patient-census levels at more than 1,400 SNFs have fallen sharply over the past five years. Patient-census levels fell from nearly 85% in 2011 to 82.2% this year, the NIC report says.

The New Jewish Home operates two SNFs in New York: a 514-bed facility with 139 post-acute-care beds in Manhattan, and a 300-bed facility with about 38 post-acute-care beds in Westchester.

With strong market fundamentals such as New York City's aging affluent community and longstanding partnerships with several tertiary hospitals, TNJH has maintained high patient-census levels, which are currently pegged at 97.95%, Weiner says. "Clearly, that is higher than national occupancy and New York state occupancy," she says.

Despite having a relatively strong market position, TNJH has embraced the necessity to boost collaboration with its hospital partners and to offer an expanded suite of services, Weiner says.


How a SNF Quality Initiative is Decreasing Hospitalizations


"We have always worked very closely with our hospitals. But as the world changed and the Affordable Care Act went into place and everybody was focusing on prevention of re-hospitalization, it became clear to us and clear to our hospitals that we needed to have a closer relationship."

The New Jewish Home's efforts to expand SNF-based services and launch new services have included creating advanced rehabilitation units, building a substance-abuse prevention program, and piloting an FDA-approved online physical therapy service, Weiner says.

"At our Manhattan campus over the past several years, we have created specialized rehab units in our SNF in collaboration with two hospitals. With NYU Langone, we created a cardiac rehab unit. With Mount Sinai Medical Center, we created an ortho unit."

"Having those kinds of programs not only embrace, but also continue the clinical pathways that the hospitals have put into place: weekly calls with the hospitals about the patients, warm transitions and warm handoffs. People actually talk with each other vs. it all being on paper. All of that allows us to be more responsive to the needs of the hospitals."


Post-Acute Care Transformation Taking Hold in SNFs


TNJH's substance-abuse program helps give the organization a competitive edge in the evolving post-acute-care marketplace, Weiner says.

"It allows hospitals that are thinking about how they are going to prevent re-hospitalization for a certain segment of their population who are abusing alcohol or drugs to say, 'Jewish Home is a place where not only can they address their hip fracture, but also they will attend an AA meeting. They will have special counseling; they will have follow-up with a substance-abuse counselor, and these added services will ensure to the best possible degree that patients do not end up back in the hospital."

In partnership with Seattle-based Jintronix, Jewish Home is piloting software that helps patients continue their rehabilitation at home, she says. "We are committed to working with our hospital partners in creating 'hospitals at home' to the degree that they are ready to do it."

All post-acute-care providers should be embracing change, Weiner says.

"The post-acute-care providers who are going to do well are going to be those who have well-trained clinical teams, are able to collect the data, provide feedback, and listen to the needs of their referral sources and their patients."

Christopher Cheney is the CMO editor at HealthLeaders.


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