Dr. Marc Rothman, Senior Vice President and Chief Medical Officer, Nursing Center Division Dr. Marc Rothman, Senior Vice President and Chief Medical Officer, Nursing Center Division

Last month I spent an evening with a dedicated group of physicians at Kindred Transitional Care and Rehabilitation Milwaukee, one of the largest skilled nursing facilities (SNFs) in the country. During his introductions, Executive Director Michael Thomas spoke passionately about the importance of communication – between physicians; physicians and nurses; nurses and nursing assistants; staff and administration and, perhaps most importantly for healthcare reform, between the acute and post-acute care settings. I could not help but think about this year’s American Medical Directors Association (AMDA) Annual Meeting in Washington D.C.

The theme at AMDA was “Monumental Steps for Quality,” and speaker after speaker talked about the need for SNFs and long-term acute care hospitals to collaborate and communicate with acute care hospitals, and not just around rehospitalizations, though that is an important topic to be sure. Other issues worth discussing included rehab outcomes, palliative care programs, formulary management, anticoagulation protocols, transitional care, disease management and even physician quality.

At Kindred, our transitional care hospitals (certified as long-term acute care hospitals, or LTACHs) have always had strong relationships with our SNFs, which allows us to Continue the Care as patients move through the healthcare continuum from one level of care to another. The relatively new interest in the continuum shown by acute care hospitals, hospital systems, insurers, and other stakeholders is a big opportunity for us. It is an opportunity to improve our quality and service, to clarify our value proposition as a lower-cost site of service, and to shine as providers of care to some of the most traditionally frail and vulnerable members of our population.

Some may disagree with this view, but the spotlight trained on SNFs and LTACHs is not going away anytime soon. In many acute care hospitals, physicians have been tasked with building relationships with the post-acute and long-term care community. What they need most of all are like-minded physicians on the SNF and LTACH side to help make these conversations work. We do this every day between our Kindred hospitals and our other post-acute settings, maybe most often the SNFs, and we hope to see these kinds of relationships grow with doctors in acute care hospitals as well.

At Kindred hospitals and SNFs, we have begun utilizing a common format, the Joint Quality Committee (JQC), as a way to organize these conversations, earn mutual trust and track shared outcomes. Successfully used in San Francisco for years – this was how I came to know Kindred’s regional leadership when I was in practice there — the JQC is now a mainstay in places like Cleveland, Boston, Las Vegas and Indianapolis, and is the scaffolding upon which new relationships are being built in North Carolina, Wisconsin and other places.

The idea has been received well. The committee meets quarterly, reviews quality, discusses and troubleshoots complaints, develops initiatives and strengthens communications. And I encourage medical directors and attending physicians to get involved. As physicians we can appreciate the positions on both sides of the table, and we are a trusted voice when our hospital colleagues pose questions about how, why, and when skilled nursing care and long-term acute hospital care is delivered the way it is.

The group in Milwaukee is taking its first steps down the road of accountability, and I applaud that. I suspect that road will merge with others and become an interstate sooner rather than later. My personal hope is that physicians won’t miss the opportunity to help steer the cars traveling along it.