Many skilled nursing and long-term care providers market "specialized" clinical services using the terms of "subacute care," "transitional care" or "rapid recovery." But do these terms really reflect true expanded clinical service capabilities or is this a marketing ploy targeted to referral sources to entice new admissions? Many providers make the easy changes, which often consist of only physical plant modifications. These may include a separate entrance; televisions and phones by each bed; new bedroom furniture; and possibly, a retrofit from semi-private to private rooms - and suddenly a new unit is created with a new name implying "expanded" clinical services. With physical environment enhancements, many nursing home providers believe that referral sources and admission decision makers, such as hospital discharge planners and health plan case managers, will assume that new clinical service capabilities and procedures are also being implemented. However, in many instances, nursing home providers continue to deliver the same basic Medicare skilled services, just as they did prior to the development of the "new" unit. These skilled services are typically focused around rehabilitation, but may also include intravenous medication management, wound care, etc. The continuing delivery of basic clinical services does not constitute a comprehensive approach to managing and caring for more truly complex residents.

 

Subacute care, and now the more popular terminology of "Transitional" or "Rapid Recovery" care, was developed in response to the expectations of Managed Care Organizations (MCOs) and hospitals looking to optimize their DRG payments. Providers were anxious to respond to the changing marketplace as they were seeing their census shrinking due to the influx of assisted living and new Section 1115 waivers. Over the years, the original program and service delivery expectations for offering true "subacute" programs fell by the wayside. Nursing home providers, in a response to Prospective Payment, reduced costs associated with "dedicated" Medicare units and certified 100% of their beds for Medicare. This, in effect, eliminated higher acuity care and minimized the importance of having specialty units.

 

More recently, providers have tried to recapture or increase referrals associated with higher acuity care, however, they are finding that by merely enhancing the physical plant, the expected increases in Medicare or Managed Care census are often not achieved. The expectations of referral sources, payors, families and residents have not changed since the inception of subacute care over 15 years ago. The original "subacute" program components of defined physician leadership, higher staffing ratios (with additional nursing competency requirements), internal facility-based case management, multifaceted interdisciplinary (or trandisciplinary) approach to care delivery, focused patient teaching and quantitative outcome measurements are still relevant and absolutely necessary if a nursing home provider wants to truly differentiate itself from the competition and gain a higher percentage of quality, higher paying referrals and retain admissions in the marketplace. Further, establishing a true subacute program can assist those nursing home providers with older physical plants with the means to compete against other nursing home providers with better locations or newer buildings. With the new SNF PPS Refinements, there are increasing opportunities for savvy providers to serve higher acuity resident and offset higher costs with improved revenues. However, to do so effectively, the provider must also ensure enhanced services to meet this population's care requirements, referral source and payor expectations.

 

Pathway Health Services has the expertise, tools and related resources that can assist you in identifying and addressing the need for your organization to provide specialized programs and services. Pathway consultants will work with your team to develop your specialty program and provide a basis for successful marketing to hospitals, insurers and Managed Care organizations.