Non-acute care is definitely evolving. The changes that are happening across providers and care environments can be a product of demographics and differing expectations of care as people age, may result from new approaches to reimbursement on the part of government and insurance industry payers, or have come from the realization that we cannot keep providing care in the same way we always have in the face of limited financial resources and a growing population needing care. Here are just a few of the many things we all should be paying attention to in this sector of care:
The Small House Model for Residential Care
The traditional model of the institutional nursing home is hardly the kind of place in which many people want to find themselves spending their final years. Many of us have a memory of visiting our elders in this kind of a place, and we want none of it in our future. Skilled Nursing News shares how in 2018 that leaves the skilled nursing industry in a quandary. They face “gigantic renovation bills if they want to convert their facilities to something like the ‘small house’ model — a style that focuses on separate, manageable living areas for smaller groups of seniors with communal kitchens and shared spaces” (Spanko, 2018). What’s clear is that creating a more desirable environment and providing these kinds of amenities will continue to become even more necessary and many of the organizations in this space are going to be making physical and cultural changes in their residential care properties.
Dehospitalization to Improve Care and Reduce Costs
Healthcare is making every effort when at all possible to bypass traditional medical centers, which are costly to run and maintain and often don’t match the way we now provide care. Some call this switch to other care modalities ‘de-hospitalization.’ One common solution is to turn to “smaller specialized surgical facilities and high-end outpatient clinics [that] are drawing patients away from the old downtown medical centers” (Leaf, 2018).Their use is accelerating significantly and should continue to do so. There is also a strong component of care available through “better homecare options—largely made possible by digital health innovations, telemedicine, and (hopefully) new payment structures— [that] will keep many patients out of the hospital to begin with” (Leaf, 2018).
CMS’s Patient Driven Payment Model (PDPM) to Reward Value
It is now very clear that CMS is working under a new set of dual goals—to reduce provider burdens and lower costs by rewarding care that produces better outcomes. One result of this effort is that “the agency is also planning a new value-based payment arrangement for skilled nursing facilities.” The Patient Driven Payment Model (PDPM), a new “type of value-based payment arrangement that would tie reimbursements to patient outcomes while also reduce reporting burdens” (Stankiewicz, 2018). Not only will this be a “bigger commitment to value-based arrangements… [but] patients will have a greater opportunity to select facilities with services tailored to their needs, giving patients more choice, a major goal of the Trump-era department” (Stankiewicz, 2018).
Medicalization of Senior Living to Handle Greater Acuity
The aging of the US population is hitting assisted living hard. A result is that “the average age of an assisted living resident continues to increase, with the current average age at 87 years, according to the Assisted Living Federation of America” (Health Dimensions Group, 2017). A significant feature is that with the “increase in age comes the natural increase in chronic conditions and increased risks such as falls” (Health Dimensions Group, 2017). It is expected that the industry will respond with “the development of different care levels to simplify the cost and pricing structure, and evaluation of each specific community to identify resources necessary to allow residents to age in place” (Health Dimensions Group, 2017). We also can expect “a continued increase in deliberate and thorough wellness and therapy programs, as well as partnerships with skilled providers such as primary care providers (e.g., physicians and nurse practitioners) and home- and community-based services (e.g., home health, hospice, and private duty agencies) to provide on-site services” (Health Dimensions Group, 2017).
Shrinking Labor Market Supports Collaboration
No one working in non-acute care is unaware of challenges with the workforce, from staff retention problems to a shortage of qualified candidates. Unfortunately, this trend will likely continue, unabated, and the “shrinking labor market will continue to affect healthcare facilities in 2018, especially in rural communities” (Health Dimensions Group, 2017). One solution is for affected facilities to “collaborate and centralize key business functions in response to staff shortages and cost concerns. To address these challenges, facilities are turning to creative solutions. Centralization will aid providers as workers with specific skills become harder to find. Healthcare providers will combine forces and centralize human resources, payroll and billing operations to gain efficiencies.
With eyes on the future, Non- and post-acute providers need to focus and work to improve the quality of care they are providing to patients who have been discharged or transitioned from acute care settings. From technology and other new tools to new approaches and partnerships, the industry will have to find a way to handle the challenges ahead.
Learn about HeathStream’s solutions for workforce development in Non-Acute Care.
Health Dimensions Group, “Top Trends in Aging Services: Healthcare Insights and Outlooks 2018,” Becker’s Hospital Review, December 11, 2017, Retrieved at https://www.mcknights.com/marketplace/2018-will-bring-significant-financial-and-regulatory-changes/article/720125/.
Hennessey, Erin, “2018 Will Bring Significant Financial and Regulatory Changes,” McKnight’s Long-Term Care News, (December 26, 2017, Retrieved at https://www.mcknights.com/marketplace/2018-will-bring-significant-financial-and-regulatory-changes/article/720125/.
Leak, Clifton, “Two Forces That Will Drive the Health Industry,” Fortune, January 3, 2018, Retrieved at http://fortune.com/2018/01/03/health-care-industry-2018/.
Spanko, A., “Top Skilled Nursing Trends of 2018,” Skilled Nursing News, January 1, 2018. Retrieved at https://skillednursingnews.com/2018/01/top-skilled-nursing-trends-2018-part-1/.
Stankiewicz, Mike, “CMS rule dump: Post-acute care providers get a pay bump, plus a new value-based payment arrangement,” FierceHealthcare, April 30, 2018, Retrieved at https://www.fiercehealthcare.com/payer/cms-rule-dump-medicare-looks-to-boost-acute-care-pay-by-x.
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