In today’s healthcare environment, no provider can afford to live in a vacuum, focused only on the level of care they are providing without regard to what happens before and after a patient comes through their system. The IMPACT Act of 2014 imposed concrete deliverables on healthcare providers related to the use of standardized patient assessment data, and the requirement and reporting of new quality measures.¹ In this new environment, post-acute care has become very important to short-term acute care (STAC) providers and vice versa.

Why Is Post-Acute Important to STAC Providers?

According to a research letter in the Journal of the American Medical Association, the adjusted percentage of hospital discharges to post-acute care among Medicare beneficiaries increased from 21% in 2000 to 26.3% in 2015.² Short-term acute care providers know that by handing patients off to post-acute providers with no further thought, they risk seeing those patients return to the hospital, which can lead to penalties and adverse patient outcomes. On top of that, consumers are pushing for coordinated care. That is, patients want to feel as though they are being handed off thoughtfully – rather than pushed out the door to start anew with the next provider. Also, the number of medically complex patients is rising – patients whose care is more complicated and requires greater coordination for successful results. According to the American Academy of PAs, the professional organization for Physician Assistants, “the absolute number of patients seeking care is increasing, and many more patients have multiple chronic conditions than they did a generation-, or even a decade-ago.”³

A 2014 paper from Acumen, LLC, posited that “integrated delivery models, such as those used by managed care plans, [could] achieve a superior level of care for highly complex patients given their systems for sharing patient histories.”⁴ Altogether, a focus on continuing the care, in an era where care is shifting from the acute to the ambulatory setting, has led STAC providers to explore the value of identifying a network of post-acute care providers in order to meet the challenges of providing better and more comprehensive care to their patients.

Why Are STAC Providers Important to Post-Acute Providers?

Post-acute care (PAC) providers are feeling the same pressures STAC providers are in today’s climate. Reducing readmissions is critical to business success; no STAC provider would continue to send patients to a post-acute facility that keeps sending those patients back to the STAC for avoidable reasons. PAC providers are also subject to payment reductions related to avoidable readmissions as we transition from a fee-for-service to a value-based care model. Penalties are incurred if the Medicare spend is higher than the average cost of care 30 days post discharge.

PAC providers know that safe and timely transitions have been proven to decrease length-of-stay, mortality and readmissions.

Creating a Network

Both STAC and PAC providers are committed to improving care transitions for better outcomes, more fluidity and a decrease in avoidable readmissions. Now what?

Achieving lasting progress entails 3 phases.

Identifying the challenges is the first step. Common challenges are:

• Effective care coordination between the inpatient team and upstream and downstream providers
• Medication reconciliation
• Patient and family education and engagement
• Quality-driven relationships with care managers and community partners
• Payer considerations

Identifying transformational steps for partnering around clinical quality is next:

• The creation of forums for jointly advancing efficiency and quality
• Implementation of institution–specific solutions and processes for enhancing clinical care
• Design of episodic clinical pathways and evidence-based discharge protocols based on patient complexity and individual care needs

And then, determination of final results:

• Evaluation of population trends in discharges and outcomes through data transparency
• Conduct analysis to understand cost of care by setting
• Risk-based contracting using select quality metrics

The environment remains ripe for the formation of networks. Although consensus-based proprietary tools exist, there is currently no universal standard for determining the most appropriate post-acute destination.

According to the American Hospital Association (AHA) Trendwatch, “Post-acute care (PAC) providers play an essential role in ensuring that patients receive the care they need to heal and have a smooth transition back to a community-based setting, typically after a discharge from a hospital. These providers face an increasingly complex regulatory and market environment as health-care transforms from a system that rewards volume to one that encourages and rewards value.”⁵

New research has shown that for certain patients, treatment in transitional, post-acute care hospital can improve outcomes and help patients move toward recovery and to a lower level of care such as home. Long term acute care hospitals (LTACs) offer highly skilled clinicians who comprise the interdisciplinary team and work closely together on treatment plans that encompass the patients’ and families' goals for healing. Unlike inpatient rehabilitation facilities and skilled nursing facilities, the care provided at an LTAC is defined by continued acute medical needs. This continued oversight of the patient is driven by effective care coordination that ensures appropriate severity of illness, intensity of service, cost effective treatment and individualized patient-family focused care plans.⁶

Components of a Good Post-Acute Collaborative

We know that the formation of networks can help to effectively meet the challenges of the healthcare landscape. How do you form a high-performing network? Below are some steps that can help you formulate a plan.

1. Identify team members and clinical point persons from each member of the network
2. Agree upon, and clearly define, expectations around common processes such as:
   • Referral decision turnaround time
   • Admission criteria by setting type
   • Transparency: “Never Admit” conditions
3. Design communication processes; referrals, transitions and real-time concerns
4. Design transition processes and pathways (upstream and downstream)
5. Define success measures; include both quality and financial goals
6. Identify reporting format and frequency
7. Outline Joint Quality Committee meeting frequency, attendance and objectives

A network can improve communication between clinicians and care settings and further supports partnerships between acute and post-acute providers. This will lead to:

• Improved patient empowerment
• Improved clinical outcomes
• Prevention of over-utilization or duplication of services
• Prevention of delays in care
• Promotion of progress towards goals
• Accountability for all

Defining Success

Once a network has been formed, it’s critical to define the metrics you will use to determine success. Some suggested key performance indicators are:

• Readmission rate: Do you see a decrease?
• Length of stay: Do you see a decrease?
• Patient volume within the network: Do you see an increase?
• Have gaps in care been identified and addressed? Are there any trends?
• Have patient satisfaction with transition and/or net promoter scores increased?
• Have follow-up calls been completed on time?
• What trends are you seeing with direct admits from home to LTAC, IRF or SNF, bypassing the hospital ED?
• Functional Improvement Measures (FIM) scores

How to Get Started

After you have identified your potential partners, you will want to gather and review your referral partner’s data, as well as your data and your competitors’ data.

Prepare your data to showcase your strengths via a visual dashboard. Approach your referral sources as well as preferred discharge providers to discuss formation of a post-acute collaborative.

When considering potential partners, you will want to consider:

• Geography
• CMS quality scores
• CMS quality websites: Hospital, IRF, Nursing Home, HH Compare
• Readmission rate
• Clinical programming and available services
• Physician alignment
• Genuine interest in participating
• Palliative and hospice care availability

When you’re both ready to move forward, you will want to complete a formal agreement (contract, affiliation, collaborative, etc.) and discuss with your legal team.

The Kindred Hospital Difference

Kindred Hospitals are part of Kindred Healthcare and are the leading provider of long-term acute care in the country. We work in acute care in 75 hospitals nationwide with over 5,500 licensed beds and 4 hospital-based sub-acute units.

At Kindred, we specialize in the treatment and rehabilitation of post-intensive care and medically complex patients who require aggressive interventions in an acute care setting. We strive to provide the ideal environment in which the expertise of physicians, nurses, therapists, rehabilitation specialists and other clinicians partner together to deliver the best care possible for seriously ill patients and their families.

Kindred Healthcare operates in the high acuity segment of the post-acute continuum and has a long history of continuing the care – from the hospital and beyond. Alignment with Kindred means a partnership with a company that knows the importance of continuity of care. We understand the complexities of delivering care at each level, from transition from the STAC through long-term acute care and rehabilitation.

Through collaboration and engagement we can work together to meet the challenges of today’s healthcare climate for our shared patients.

To learn more about our services, please reach out to your Kindred representative, contact us or visit us online at www.kindredhospitals.com.

References:

1. hhttps://www.finance.senate.gov/imo/media/doc/IMPACT%20Section-by-Section%20FINAL.pdf
2. Werner R Konetzka T. Trends in Post–Acute Care Use Among Medicare Beneficiaries: 2000 to 2015JAMA. 2018;319(15):1616-1617. doi:10.1001/jama.2018.2408
3. https://www.aapa.org/news-central/2017/02/patients-complex-patients/
4. MaCurdy T  Bhattacharya J. Challenges in Controlling Medicare Spending: Treating Highly Complex Patients. Acumen, LLC. May 2014.
5. American Hospital Association. (2015, December). The Role of Post-Acute Care in New Care Delivery Models.
6. LTACH 101 by Christy J. Dagley, RRT, BAS. https://www.michiganrc.org/docs/MSRC_2017_LTACH_and_the_RT_role.pdf