Anne TumlinsonA leader in the health and aging services space, Anne Tumlinson, tells Provider in a question-and-answer session that skilled nursing facilities (SNFs) and long term and post-acute care (LT/PAC) providers in general should be monitoring acute-care hospital volumes, technology changes, and home-based care, among other issues, to bolster their opportunities.

Tumlinson, chief executive officer of Anne Tumlinson Innovations and founder of the Daughterhood website and blog, says the shifts taking place inside and outside the LT/PAC profession are significant. Here are her thoughts on current trends and the need for SNFs in particular to diversify even as the population ages.

Provider: What trend is flying under the radar right now?

Anne Tumlinson (AT):
This really is not getting a lot of attention, but the significant decline in the use [volumes] of the inpatient setting and migration to the outpatient for surgical procedures is a huge trend. This factor is contributing as much as value-based care in terms of the decline in volume [for acute-care hospitals], and it is definitely going to continue.

The question is what sort of future is there for the inpatient hospital, and as long as the SNF is dependent on the inpatient hospital for referrals, what will this mean to SNFs if their volumes [admissions] are tied to inpatient hospitals if hospitals become dinosaurs?

It doesn’t matter how many baby boomers there are [aging into SNFs], since I think these lower hospital volumes would be the most worrisome issue for SNFs. And I feel like it is not getting much attention.

An example is I received an email to my website Daughterhood for caregivers, and several readers email and ask, ‘Why is my 94-year-old dad only getting one night in the hospital?’ He is getting outpatient care and the family is upset because they wanted rehab and a SNF and need help but cannot get it because it is not covered.

Provider: What do you make of what technology means to LT/PAC providers?

When you talk about acceleration in the adoption of technology, it sounds like ‘duh,’ since it may be obvious. But, it’s been a little bit slow to take hold in some cases, and I think there are rapid improvements being made in technology.

In the last year, I’ve had so many more conversations with tech-based companies that are innovating new kinds of technology that dramatically improve the way PAC providers can manage patient care and interact with patients and families. And, I was a skeptic in this area but not anymore after being exposed to more and more of these companies.
Provider: Are these technologies good or bad for SNFs in that home care may improve with things like telemedicine?

No, I don’t see them as a threat, I see them as a complement because technology really enables PAC providers to connect themselves to home-based providers. It gets them into the home, and those home care providers want to be complementary to facility-based care. The idea is that we will start connecting to all the different parts of the care delivery system.

There are some companies that are being really innovative and white labeling their products in seniors housing and offering to PAC providers. They have a sort of ready-made solution for people who live in their buildings who need additional home care labeled under their brand, and technology is sort of the underpinning of all that.

Provider: Diversification is called a key for survival for LT/PAC providers. What do you see happening in that regard?

Another thing that is exciting and a little bit cutting-edge is that a handful of SNFs are changing their entire business from being facility providers to being sort of PAC companies that take risk for the whole PAC continuum. Sort of like a Remedy Partners. But we will see actual PAC providers start to claim that space a little bit if they can get a toehold on the sort of the relationship with the physicians and the docs.

Provider: You have spoken about opportunities, but what are the challenges for SNFs?

I think, unfortunately, the volume pressures SNFs have been experiencing over the last year or two or so will continue, and I do not see that abating. And the new bundled payment program [under the Trump administration] will only get worse unless they can get some kind of traction themselves as PAC providers. I struggle to offer solutions, frankly.

There are some basic block and tackle strategies they need to be really, really good at right now. They need to be offering very strong SNF programming, and they need to be data and marketing ninjas just to keep some Medicare volume flowing to them.

The only other path, quite frankly, is to become a risk holder, which just means to look for and consider every opportunity to take health care risk, whether as a convener in bundled payment—hard to do—or through value-based contracting with managed care plans or even becoming a managed care plan for long-stay residents. It sort of blows people’s minds when I say this, but I can’t really come up with any other futures for SNFs that don’t include this to some degree.