SNF Q and A

November 5th, 2012 by Nick Jacobs Leave a reply »


Question:   Is the percentage of readmissions to hospitals known and is it published publicly? I have seen some percentages in journals in regards to percentage of readmissions, but no statistical analysis of various states etc

Well, it is definitely known by each hospital. One of the interesting things about the Accountable Care Act is that transparency will become more and more the norm rather than the exception. I believe that, as we all know, COPD, Heart Failure, Cancer et al are the primary reasons for readmissions. Five to seven percent of the population uses most of the Medicare dollars currently being spent. I believe that Kaiser Permanente is one of the only health systems in the U.S. that originally took a very aggressive stand on this issue. They employed a home nursing service to monitor patients after discharge to keep patients out of the hospital. SOMEONE has to watch out for that. We are also working with firms that provide oversight for these patients.

Question: How are hospitals identifying these readmissions?

We call them, “the frequent fliers.” In the past there was no reason to limit those readmissions. All of my insightful clients are working with me to introduce health and wellness activities to their outreach centers and to their community. We KNOW who they are. The other problem is that, without health insurance coverage or a primary physician, and without them taking responsibility for their own health, there is NOTHING that will keep these frequent fliers from coming back as patients. SNF’s are not big risk takers . . . when in doubt, send them to the hospital? It’s a necessary tactic for the SNF’s, but it is also something that SNF’s could partner with hospitals to address much more efficiently.

Question: Are there trends being identified in the source of these readmissions? such as nursing facility, assisted living, diagnosis?

All of the above and NONE of the above. The reason that so many hospitals will merge or sell is that the leadership often times does not know what or how to the current culture or activities and change brings risk.  Some of these are the same hospitals that did not or could not invest in Electronic Medical Records, have not looked for prevention opportunities, and have not addressed problems dealing with infection control adequately. Just a note that nursing homes are also a major source of infections in hospitals, and the hospitals will be penalized for all hospital acquired infections as well.

Question: Are hospitals communicating this information to the skilled nursing facilities in order to minimize those readmissions that are not necessary? Are there measures being put in place to better address the clinical needs in the facility proactively to prevent readmission?

Yes and no . . . if they own them, they may be.  It appears that very small steps are being introduced.

Question: SNF’s are currently not identified in the ACO rule, but do hospitals see them as a part of the continuum of care? SNF’s are a nice transition for those residents who have higher clinical needs that are not yet ready to return home. SNF’s have lower costs than hospitals and clinical staff to manage frail patients.

SNF’s have the same problems as Hospitals, and New Jersey and Florida are already implementing managed care contracts to SNF’s that will further restrict their profitability.  PA is right behind them in this managed care decision.   I recently made a proposal to a SNF listing creative ways to lower their costs, increase their profitability and partner with their local hospital systems. They opted instead to look at further staff cuts and reductions. This is the same path many hospitals are taking.  It is the easiest but not always the best way to reduce costs.  It also can reduce quality, patient and employee satisfaction.  Communications between providers must happen in order for them to survive and thrive.

The truly enlightened organizations are stepping up because they have ACO’s and see that, for example, the $240K they will be spending on personnel for the wellness facility that their employees and patients use is the cost of ONE readmission. It doesn’t take much to figure out that if you can prevent a heart attack, even stents, it’s worth a small investment, but, unfortunately, we have lived off the Medicare entitlement concept so long and been rewarded for treating illness for so long, that addressing wellness will require change. In the book “Change or Die” the statistic is that 90% of us choose DEATH over change.

One of my special areas of qualitative focus is HCHAPS. One health system that I’m aware of will be penalized about $23M because of low HCHAP scores, and THEY HAVE RELATIVELY GOOD SCORES.  Image the hospitals with HCHAP scores lower than the average prison hospital. They need to retool, treat their EMPLOYEES and their PATIENTS with respect and allow them to be treated with dignity.

Question:   Can you identify some ACO’s and is there any data in regards to their success or failure in regards to reduced costs or reimbursement gain from the Shared Savings Program? In the most recent list published ACO’s there are 88 identified.

It is too early to determine the success rates of ACO’s. The goals are very clear for them, however, and they will be rewarded handsomely if they succeed. I’m working primarily in New Jersey and Florida, and there are prime examples of forward looking organization that already have ACO’s. We have helped generate millions to build workout and wellness facilities for  patients and employees. At least one has employed Integrative Medicine employees who are treating thousands of inpatients and countless outpatients a year with acupuncture, massage, reiki, etc., and are creating a womb like environment with hands on counseling for wellness and prevention activities. Plus they are making money in many ways from these investments. I once had a CEO who used to tell our management team that, “If we can’t figure out how to do this, I guarantee that SOMEONE can and WILL figure it out.”   That is the bottom line.



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