In right this moment’s healthcare setting, no supplier can afford to reside in a vacuum, centered solely on the extent of care they’re offering with out regard to what occurs earlier than and after a affected person comes via their system. The IMPACT Act of 2014 imposed
concrete deliverables on healthcare suppliers associated to using standardized affected person evaluation knowledge, and the requirement and reporting of recent high quality measures.1 On this new setting, post-acute care has grow to be crucial
to short-term acute care (STAC) suppliers and vice versa.
Why Is Publish-Acute Necessary to STAC Suppliers?
Based on a analysis letter within the Journal of the American Medical Affiliation, the adjusted share of hospital discharges to post-acute care amongst Medicare beneficiaries elevated from 21% in 2000 to 26.3% in 2015.2 Quick-term
acute care suppliers know that by handing sufferers off to post-acute suppliers with no additional thought, they threat seeing these sufferers return to the hospital, which may result in penalties and antagonistic affected person outcomes. On high of that, customers are
pushing for coordinated care. That’s, sufferers need to really feel as if they’re being handed off thoughtfully – relatively than pushed out the door to start out anew with the following supplier. Additionally, the variety of medically complicated sufferers is rising –
sufferers whose care is extra difficult and requires higher coordination for profitable outcomes. Based on the American Academy of PAs, the skilled group for Doctor Assistants, “absolutely the variety of sufferers looking for care
is rising, and lots of extra sufferers have a number of power circumstances than they did a generation-, or perhaps a decade-ago.”3
A 2014 paper from Acumen, LLC, posited that “built-in supply fashions, equivalent to these utilized by managed care plans, [could] obtain a superior degree of take care of extremely complicated sufferers given their techniques for sharing affected person histories.”4 Altogether,
a deal with persevering with the care, in an period the place care is shifting from the acute to the ambulatory setting, has led STAC suppliers to discover the worth of figuring out a community of post-acute care suppliers so as to meet the challenges of offering
higher and extra complete care to their sufferers.
Why Are STAC Suppliers Necessary to Publish-Acute Suppliers?
Publish-acute care (PAC) suppliers are feeling the identical pressures STAC suppliers are in right this moment’s local weather. Lowering readmissions is essential to enterprise success; no STAC supplier would proceed to ship sufferers to a post-acute facility that retains sending
these sufferers again to the STAC for avoidable causes. PAC suppliers are additionally topic to fee reductions associated to avoidable readmissions as we transition from a fee-for-service to a value-based care mannequin. Penalties are incurred if the Medicare
spend is greater than the common value of care 30 days put up discharge.
PAC suppliers know that protected and well timed transitions have been confirmed to lower length-of-stay, mortality and readmissions.
Making a Community
Each STAC and PAC suppliers are dedicated to enhancing care transitions for higher outcomes, extra fluidity and a lower in avoidable readmissions. Now what?
Reaching lasting progress entails 3 phases.
Figuring out the challenges is step one. Widespread challenges are:
- Efficient care coordination between the inpatient crew and upstream and downstream suppliers
- Remedy reconciliation
- Affected person and household training and engagement
- High quality-driven relationships with care managers and group companions
- Payer concerns
Figuring out transformational steps for partnering round scientific high quality is subsequent:
- The creation of boards for collectively advancing effectivity and high quality
- Implementation of establishment–particular options and processes for enhancing scientific care
- Design of episodic scientific pathways and evidence-based discharge protocols primarily based on affected person complexity and particular person care wants
After which, willpower of ultimate outcomes:
- Analysis of inhabitants traits in discharges and outcomes via knowledge transparency
- Conduct evaluation to know value of care by setting
- Danger-based contracting utilizing choose high quality metrics
The setting stays ripe for the formation of networks. Though consensus-based proprietary instruments exist, there may be presently no common customary for figuring out essentially the most applicable post-acute vacation spot.
Based on the American Hospital Affiliation (AHA) Trendwatch, “Publish-acute care (PAC) suppliers play an important function in guaranteeing that sufferers obtain the care they should heal and have a easy transition again to a community-based
setting, sometimes after a discharge from a hospital. These suppliers face an more and more complicated regulatory and market setting as health-care transforms from a system that rewards quantity to at least one that encourages and rewards worth.”5
New analysis has proven that for sure sufferers, remedy in transitional, post-acute care hospital can enhance outcomes and assist sufferers transfer towards restoration and to a decrease degree of care equivalent to dwelling. Long run acute care hospitals (LTACs) provide extremely
expert clinicians who comprise the interdisciplinary crew and work intently collectively on remedy plans that embody the sufferers’ and households’ objectives for therapeutic. In contrast to inpatient rehabilitation services and expert nursing services,
the care offered at an LTAC is outlined by continued acute medical wants. This continued oversight of the affected person is pushed by efficient care coordination that ensures applicable severity of sickness, depth of service, value efficient remedy
and individualized patient-family centered care plans.6
Parts of a Good Publish-Acute Collaborative
We all know that the formation of networks might help to successfully meet the challenges of the healthcare panorama. How do you kind a high-performing community? Under are some steps that may assist you formulate a plan.
- Determine crew members and scientific level individuals from every member of the community
- Agree upon, and clearly outline, expectations round frequent processes equivalent to:
- Referral choice turnaround time
- Admission standards by setting sort
- Transparency: “By no means Admit” circumstances
- Design communication processes; referrals, transitions and real-time issues
- Design transition processes and pathways (upstream and downstream)
- Outline success measures; embrace each high quality and monetary objectives
- Determine reporting format and frequency
- Define Joint High quality Committee assembly frequency, attendance and aims
A community can enhance communication between clinicians and care settings and additional helps partnerships between acute and post-acute suppliers. It will result in:
- Improved affected person empowerment
- Improved scientific outcomes
- Prevention of over-utilization or duplication of providers
- Prevention of delays in care
- Promotion of progress in direction of objectives
- Accountability for all
As soon as a community has been fashioned, it’s essential to outline the metrics you’ll use to find out success. Some advised key efficiency indicators are:
- Readmission price: Do you see a lower?
- Size of keep: Do you see a lower?
- Affected person quantity throughout the community: Do you see a rise?
- Have gaps in care been recognized and addressed? Are there any traits?
- Have affected person satisfaction with transition and/or internet promoter scores elevated?
- Have follow-up calls been accomplished on time?
- What traits are you seeing with direct admits from dwelling to LTAC, IRF or SNF, bypassing the hospital ED?
- Useful Enchancment Measures (FIM) scores
Easy methods to Get Began
After you’ve gotten recognized your potential companions, you’ll want to collect and evaluate your referral accomplice’s knowledge, in addition to your knowledge and your opponents’ knowledge.
Put together your knowledge to showcase your strengths through a visible dashboard. Method your referral sources in addition to most well-liked discharge suppliers to debate formation of a post-acute collaborative.
When contemplating potential companions, you’ll want to think about:
- CMS high quality scores
- CMS high quality web sites: Hospital, IRF, Nursing Dwelling, HH Evaluate
- Readmission price
- Scientific programming and obtainable providers
- Doctor alignment
- Real curiosity in collaborating
- Palliative and hospice care availability
While you’re each prepared to maneuver ahead, you’ll want to full a proper settlement (contract, affiliation, collaborative, and many others.) and focus on along with your authorized crew.
The Kindred Hospital Distinction
Kindred Hospitals are a part of Kindred Healthcare and are the main supplier of long-term acute care within the nation. We work in acute care in 75 hospitals nationwide with over 5,500 licensed beds and 4 hospital-based sub-acute models.
At Kindred, we specialize within the remedy and rehabilitation of post-intensive care and medically complicated sufferers who require aggressive interventions in an acute care setting. We try to supply the perfect setting wherein the experience of physicians,
nurses, therapists, rehabilitation specialists and different clinicians accomplice collectively to ship the perfect care doable for significantly in poor health sufferers and their households.
Kindred Healthcare operates within the excessive acuity section of the post-acute continuum and has a protracted historical past of constant the care – from the hospital and past. Alignment with Kindred means a partnership with an organization that is aware of the significance
of continuity of care. We perceive the complexities of delivering care at every degree, from transition from the STAC via long-term acute care and rehabilitation.
Via collaboration and engagement we are able to work collectively to satisfy the challenges of right this moment’s healthcare local weather for our shared sufferers.
To study extra about our providers, please attain out to your Kindred consultant, contact us or go to us on-line at www.kindredhospitals.com.
Werner R Konetzka T. Tendencies in Publish–Acute Care Use Amongst Medicare Beneficiaries: 2000 to 2015JAMA. 2018;319(15):1616-1617. doi:10.1001/jama.2018.2408
MaCurdy T Bhattacharya J. Challenges in Controlling Medicare Spending: Treating Extremely Advanced Sufferers. Acumen, LLC. Might 2014.
American Hospital Affiliation. (2015, December). The Position of Publish-Acute Care in New Care Supply Fashions.
LTACH 101 by Christy J. Dagley, RRT, BAS. https://www.michiganrc.org/docs/MSRC_2017_LTACH_and_the_RT_role.pdf