What do ACO s and Hospitals want from SNF s and CCRC s

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1 What do ACO s and Hospitals want from SNF s and CCRC s Presented to the Institute of Senior Living, April 11, 2013 A Division of Kindred Healthcare 1

2 Assessing the match: What hospitals and ACO s currently want from post acute care providers and CCRC s What do ACOs & Hospitals want from SNFs and Communities? What do SNFs want from ACOs? Marketing Analysis- an in depth look and plan Continuum Development what is your offering? Steps to get a seat at the table 2

3 Accountable Care Organizations What do ACOs & Hospitals want from SNFs? Nursing/Rehab clinical excellence Documentation of quality outcomes All collecting, defining, and reporting identically System to track readmissions Process for continuous improvement Quality physical plant Medical Director leadership Willingness to participate in ACO payment plan 3

4 What do ACOs & Hospitals want from SNFs and Communities Nursing/Rehab clinical excellence Defined as Full time PT OT ST; Access to clinical outcome information for Rehab Patients by diagnosis and discipline Managed Care proficient i.e.- efficiencies in the delivery of care Outpatient rehab onsite Wellness programs and education to residents Short term stay experience and bed availability 4

5 What do ACOs & Hospitals want from SNFs and Communities Documentation of quality outcomes All collecting, defining, and reporting identically Facilities may want to determine which ACO they wish to join before adopting an EMR on their own Partner with providers that can support clinical outcomes; Pharm, Rehab, etc. 5

6 What do ACOs & Hospitals want from SNFs and Communities System to track readmissions Process for continuous improvement Hard statistics and solid data, preferably provided by the medical director, to show the care at the facility and to demonstrate to ACOs that the likelihood of hospital readmission from that SNF would be less than at other facilities. What partnerships are in place to support readmissions if need be? Do you have direct admit arrangements with other Hospitals i.e. LTACH s 6

7 What do ACOs & Hospitals want from SNFs and Communities Quality physical plant SNF s will need to look attractive to hospitals and ACOs with whom they are looking to partner. Tour ready facilities Tour ready Rehab Departments Customer service friendly staff Clean and clear admission to discharge processes 7

8 What do ACOs & Hospitals want from SNFs and Communities Medical Directors leadership and role in the care for residents in the facility: Medical Directors have to be actively communicating with ACOs and hospitals about the quality of care the facility provides. Medical Directors cannot be relied upon to simply be the physician of record for the patients. Lead Medical Directors need to be actively engaged in clinical education and pathway development in alignment with local ACO/Continuum models Other roles for the Medical Director active liaison to other physicians, active participant in the evolution of medical care at the post-acute care setting. 8

9 Accountable Care Organizations What do SNFs want from ACOs? Complete patient record (meds, labs, tests, final DRG) If not complete at time of transfer, then as soon as available System to track patient health changes Communication established for 24/7 access MD, PA, or NP Established process for continuous improvement Participation in care path planning & implementation Transparency in tracking quality outcomes All collecting, defining, and reporting identically 9

10 Marketing Analysis- in-depth look Do your research; internal and external Gather re-admission rates by hospital Outline current specialty care and or clinical programs that the nursing and rehab team are successful at providing care for- What are you known for? Complete an in-depth analysis of your Market

11 Medicare Tables Sample Market Analysis Glossary -ALOS = average length of stay (days) -GMLOS = geometric mean length of stay (DRG payment days) -Avoidable days = number of days stayed after DRG payment days -Service line = categories of similar medical conditions

12 Boone Hospital - Service Line by D C Disposition MCR Cases Home SNF HHS Died IRF Hospice LTACH Acute Other Total SNF Cardiology 1, ,272 9% Orthopedics ,963 28% Pulmonary % Gastroenterology % General Surgery % Neurology % General Medicine % Nephrology % Vascular Surgery % Open Heart % Oncology % Rehabilitation % Urology % Endocrine % Neurosurgery % Hematology % Thoracic Surgery % Gynecology % Dermatology % Otolaryngology % Psych % Trauma % Rheumatology % Total 5,580 1,751 1, ,852 18% 57% 18% 16% 3% 3% 1% 1% 1% 0% 100% Source: CMS, MedPAR 2011; Truven Health

13 Boone - >5 ALOS Avoidable Day Estimate Cases > 5 LOS # Pts. ALOS GMLOS Pt. Days GM Days Avd Days Pot. $800/d Total 2, ,528 15,335 10,193 $8,156,424 Pulmonary ,746 2,111 1,635 $1,308,325 Cardiology ,045 1,527 1,518 $1,214,701 General Surgery ,258 2,847 1,411 $1,129,080 Orthopedics ,512 1,451 1,061 $849,011 General Medicine ,028 1, $772,992 Gastroenterology , $758,588 Neurology , $447,311 Nephrology , $444,110 Oncology $276,869 Vascular Surgery $187,246 Open Heart ,732 1, $148,837 Urology $143,236 Dermatology $133,633 Hematology $100,025 Neurosurgery $100,025 Endocrine $88,822 Gynecology $23,206 Psych $22,406 OB/Delivery $20,005 Otolaryngology $12,803 Trauma $8,002 Rheumatology $7,202 Obstetrics $4,001 Thoracic Surgery , ($41,610) Source: CMS, MedPAR 2011; Truven Health

14 Care Continuum- what can your community offer? SHORT-TERM ACUTE CARE HOSPITALS LONG-TERM ACUTE CARE HOSPITALS INPATIENT REHAB SKILLED NURSING FACILITIES ASSISTED LIVING OUTPATIENT REHAB HOME HEALTH CARE HOSPICE Higher Intensity of Service Lower

15 Potential partners to develop the continuum offering Medical Home Model Care Management Resources Transition Coaches (liaisons) Physician Home Practitioner Clinical care paths extended to SNF/AL Physician Assistant (specialist or generalist) Radiology Therapy Geriatrician On-site Pharmacist Hospitalists ( SNF-ists )

16 Steps to get a seat at the table -IT preparedness for data collection, reporting, and adaptability to change- identify what is needed Quantify own: o clinical strengths- including the Medical Director leadership o operational performance, o patient outcomes, o quality metrics Outline relationship with similar post acute providers; LTACH s, Home Healthcare, Outpatient Rehab Services Present a persuasive offering to partner with the referral resources to take high cost targeted patients- Market Analysis

17 Thank you Contact: Paula Avriett West Region -Director of Business The content in this presentation is a accumulation of thoughts and research from various internal, external and available industry sources.

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