In recent years, nursing homes have faced challenges with how they get paid. Reimbursement issues have pushed many facilities to rethink their payment models. A growing trend among nursing homes is the increased use of Institutional Special Needs Plans (I-SNPs) and Accountable Care Organizations (ACOs). These models are designed to improve the quality of care while managing costs. However, they come with their own set of challenges, especially regarding discharge processes and administrative tasks.
The Need for Strategic Planning
Operating under I-SNPs and ACOs can be complex. Nursing home operators have found that managing these value-based care models requires detailed planning and coordination among staff, starting from the admission of a new resident. Although these models can be tricky to implement, when done correctly, they can lead to better outcomes for both residents and facilities.
Insights from Genesis HealthCare
Julie Britton, the Chief Clinical Officer at Genesis HealthCare, explains how these plans have brought efficiencies to their operations. "Our centers follow the triple aim: safe, efficient, cost-effective care," Britton says. She acknowledges that while participating in I-SNPs and ACOs has streamlined processes, it can sometimes be difficult to manage.
Genesis HealthCare is a large organization with over 200 skilled nursing centers and senior living communities across 19 states. In addition, it provides rehabilitation therapy at more than 1,400 locations nationwide. The scale of its operations means that implementing these new payment models can significantly impact its efficiency and care quality.
Challenges in Managing ACOs and I-SNPs
Delena Stortz, the Chief Nursing Officer at Consulate Health Care, points out that although ACOs and I-SNPs have benefits, they also present unique challenges. One major issue is the pressure to reduce residents' time in the facility. This urgency can complicate discharge planning, as staff may need to negotiate for more time to ensure that discharges are safe and appropriate.
Stortz explains, "We want to ensure the discharge is safe and appropriate. Sometimes we have to go back to the provider and say, 'Wait, we need more time.'" Consulate Health Care is recognized as a leading provider of senior healthcare services, offering a wide range of care, from rehabilitation to specialized dementia services across several states.
The Importance of Comprehensive Care Planning
At Ignite Medical Resorts, Chief Medical Officer John McFarlane emphasizes the importance of providing a full clinical picture. When working with I-SNPs and ACOs, having all relevant medical information helps ensure better resident outcomes. McFarlane notes, "If we discharge too early, there's a risk of readmission, which can be costly."
Ignite Medical Resorts operates 20 facilities across seven states and is known for blending advanced rehabilitation with a luxurious experience. They focus on ensuring that residents receive comprehensive care that fully addresses their needs.
A Team Approach to Value-Based Care in Nursing Homes
Both Ignite and Genesis stress the importance of a team approach to care. This means that from the moment a resident is admitted, all staff members—including doctors, nurses, and administrative personnel—work together to create a detailed care plan. This approach helps residents and their families understand their care options and what to expect during their stay. McFarlane states, "It's challenging, but we focus on comprehensive, interdisciplinary care planning upon admission." This planning helps everyone stay informed and align with the residents' needs.
At Genesis HealthCare, Britton highlights the importance of addressing potential issues early on. "We review medications, equipment needs, and appointment schedules upfront," she explains. This thorough preparation is key to delivering safe and effective care, ultimately helping to avoid complications that could lead to hospital readmissions.
The Role of Discharge Planning
Effective discharge planning is crucial in value-based care models. Consulate Health Care's Stortz emphasizes that aligning goals among care providers and families ensures safe transitions back home. "It's important to have consensus on care goals to ensure safe transitions," she says. Cost is always a consideration, but it should never compromise patient care and outcomes.
Collaborating with Hospitals and Community Providers
As nursing homes adapt to I-SNPs and ACOs, collaboration with hospitals and community providers becomes increasingly important. Better communication and partnerships can lead to smoother transitions for residents, reducing the chances of unnecessary readmissions.
McFarlane highlights the need for nursing homes to work closely with hospital systems. By doing so, they can create a more seamless experience for residents transitioning from hospitals to skilled nursing facilities, minimizing complications that could arise from miscommunication or rushed discharges.
Embracing Technology in Value-Based Care
Many nursing homes are turning to technology to streamline processes and reduce administrative burdens. Justin Di Rezze, CEO of Theoria Medical, emphasizes the benefits of technology in managing value-based care. "Joining an ACO or I-SNP should simplify life for operators and patients, not complicate it," Di Rezze explains.
Using advanced discharge planning tools and technology-driven solutions, nursing homes can better manage care timelines, ensuring that residents receive the care they need while controlling costs.
Conclusion: The Future of Skilled Nursing Care
In conclusion, a proactive approach is essential as nursing homes navigate the complexities of value-based care models like I-SNPs and ACOs. By focusing on comprehensive care planning, interdisciplinary teamwork, and effective collaboration with hospitals, facilities can maximize the benefits of these new payment models.
The shift towards integrated care models prioritizes patient outcomes and promotes a more sustainable and efficient healthcare system. While challenges exist, skilled nursing facilities' ongoing efforts to adapt and innovate will play a critical role in shaping the future of senior care.
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