Survey Reveals Post-Acute Care in Transition to Continuing Care
No longer just the province of discharge planners and case managers, post-acute care (PAC) has emerged as a major strategic concern for health systems as they seek to reduce readmissions, rein in Medicare Spending per Beneficiary, prepare for bundled payment and, most important, improve patient outcomes and satisfaction. As the predominant payer for post-acute care, spending $59 billion in 2013 just on fee-for-service PAC, Medicare is leading the charge to control costs and improve quality, with an array of initiatives and policy changes in the works.
Recognizing that post-acute care is now top of mind for many health care executives, Sg2 recently surveyed members on PAC goals, leadership and practices. The results paint a picture of post-acute care in transition. In some organizations, post-acute care still functions as discharge disposition in its own silo. More progressive health systems are developing the new organizational structures, technology, roles and processes needed to integrate post-acute care as part of what Sg2 is calling continuing care—a high-value component of a seamless System of CARE. The concept of continuing care suggests that patients are not discharged at the end of their inpatient stay but rather that care continues in another well-aligned and coordinated setting. Our survey illustrates some aspects of this transition.
Strategic Goals: Moving Beyond Readmissions
It’s not surprising that a sizable proportion (35%) of members surveyed cited “decrease readmissions” as the principal goal of their PAC strategy, while others identified driving revenue growth to PAC sites and services as their main goal. What is surprising is that the largest number of respondents (44%) chose “align acute and post-acute episodes of care to manage the total cost of care” as their organization’s principal PAC goal—an indication of a broader, more progressive view of this sector.
Measures of Value: Not So Much
Even so, the survey replies still reflect the importance of readmission rates in assessing the value of the PAC network. A whopping 91% of respondents said they use readmission rates to measure value. Other conventional metrics—rates of unplanned ED visits, patient satisfaction—were also widely cited. Fewer than half of those surveyed reported using more progressive PAC metrics such as functional improvement score and dollar spend.
PAC Leadership: An Executive Function
A survey question on leadership also revealed room for improvement. Only 28% of our survey group said their organization has an executive in charge of post-acute care. Nearly 40% reported their system has no clear leader of post-acute care planning. The remaining respondents said PAC planning fell to the heads of other departments or functions.
In our view, health systems should identify a high-level leader to build the structures, processes and partnerships needed to ensure coordinated post-acute care. Consolidating post-acute care under a single executive raises its profile, streamlines decision making and collaboration with partners, and provides the strategic direction needed for success.
PAC Placement: Still More Art Than Science
Choice of a PAC level (long-term acute care, inpatient rehab, skilled nursing facility, home health) has long been somewhat subjective. And the selection of a particular provider or site often depends on many different factors—availability, geography, patient and family preference, and network or other relationships. However, progressive organizations are beginning to make more objective and data-driven decisions on placement. Some health systems have developed their own discharge planning tools, and PAC technology to guide care teams in choosing the appropriate level of care and speed the selection of a particular provider is beginning to emerge in the market. Advanced organizations are even using predictive analytics to ensure the patient is placed in the right level of care, at the right time, with the greatest likelihood of reaching medical and/or functional goals.
Our survey indicated most health systems have not begun to use these newer tools. Of respondents, 78% indicated that PAC placement was chiefly based on the recommendation of a case manager, social worker or physician. The remainder reported using a specialized algorithm or patient pathway.
Wherever your organization currently stands in the transition to efficient, high-quality continuing care, Sg2 has a wealth of resources to help you navigate. Post-acute care continues to be an area of focus for us. We have numerous PAC strategy projects under way with clients and will be releasing 2 reports on this crucial topic in the coming months.
Sources: Miller ME, Executive Director, MedPAC. Medicare post-acute care reforms. Testimony before the Subcommittee of Health, Committee on Energy and Commerce, US House of Representatives. April 16, 2015. http://docs.house.gov/meetings/IF/IF14/20150416/103327/HHRG-114-IF14-Wstate-MillerM-20150416.pdf; Sg2 Survey, 2015.