A key element of health reform is introducing new ways to reward hospitals for good outcomes and penalize hospitals for poor outcomes. In this new environment, hospital strategies may influence referral patterns and significantly impact the business of post-acute providers.
Two of the most impactful changes to a hospital’s bottom line—30-day readmission penalties and bundled payments covering the entire continuum of care—are significantly affected by what happens to patients when they leave the hospital. These market forces will demand that hospitals develop stronger relationships with long term and post-acute care organizations that provide effective and efficient care post-discharge.
This is especially true for preventable conditions such as fall-related injuries and complications from undetected urinary tract infections (UTIs).

Improving Relationships With Hospitals

Accountable care requirements are causing shifts in the industry, making collaboration and partnership across the spectrum of care more prevalent. This trend is already affecting long term and post-acute care providers.
Falls and HospitalizationsThe traditional business model of long term care facilities focuses on providing a place of residence for someone who needs support with daily living. In the future, that model will not lead to market leadership. Already, long term care facilities are shifting the way they operate to provide services for those older adults who want to age in place.
There is greater appetite for innovation, including long term care providers that distinguish themselves with new approaches and services to become a provider of choice when hospitals look to develop patient referral networks.
Providers may be hesitant to rewire a business model that has been successful, yet those that do not take a new approach will almost certainly lose market share.

Standing Out

There are a few key characteristics hospitals will most likely assess when deciding which long term or acute-care providers should be part of their preferred network for referrals. Hospitals will choose long term care facilities that have some level of clinical services to provide support for residents who leave the hospital.
Facilities that are innovative in how they care for residents, show an expertise in understanding the needs of newly discharged patients, and provide 360-degree care will be in a good position to succeed.
Technology can be a useful tool as long term and post-acute care providers develop strategies to differentiate and make themselves more attractive to hospitals.
For example, smart sensor technology provides information to staff that can help facilitate the right care at the right time and help improve patient health and well-being. The technology, which is already being used in senior living communities, can help mitigate potential readmission risks, such as falls and UTIs, to improve quality of care and safety.
A Mutual BenefitUTIs are the second leading cause for hospitalization in seniors age 65 and older. Detecting a UTI early can be the difference in being hospitalized or treated as an outpatient, which could potentially save a hospital from financial penalties.
Early signs include frequent urination at night. Long term or acute-care facilities that have smart sensor technology can detect if a resident used the restroom an unusually high number of times in one night, and the technology sends an alert to a staff member. That staff member could check on the resident, test for a UTI, and, if it came back positive, treat it before it becomes more serious and requires hospitalization.
Falls are another example of where smart sensor technology may help prevent hospital admissions.
Thirty-three percent of seniors fall every year, causing 662,000 hospitalizations. Additionally, the rate of falling after a hospitalization is four times as likely within the first two weeks after discharge, compared with the first three months.
Smart sensor technology can detect when there is a different pattern or inactivity in a patient room and will send an alert to a staff member. If a resident falls in the bathroom and smart sensor technology recognizes that there has been no movement for 30 minutes, a caregiver is alerted to check on him.
While smart sensor technology cannot detect a fall, it can measure the activity within a patient’s room and help detect differences.
Helping a patient after a fall within the golden hour increases the patient’s survival rate and may allow the long term or acute-care facility to care for the patient before complications arise that require hospitalization.

Moving The Industry Forward

Strong partnerships between hospitals and long term care providers are a relatively new idea, and there is no set formula for success. What will this shift in care look like? What amount of care should be provided at a nursing home, and what role should it play in coordinating care? How can long term and acute-care facilities shift their business models to partner with hospitals? These questions have yet to be answered, but they will be in time. And first movers will have the most influence and reap the biggest rewards as hospitals and health systems look for dependable and innovative partners.
Julie Cheitlin Cherry, RN, MSN, director of clinical services, Intel-GE Care Innovations, can be reached at (408) 835-8716 or at julie.cherry@careinnovations.com.