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A successful ACO must have a strong long-term care component

April 4th, 2011

by Anthony Cirillo

I perform work on "both sides of the house," that is I consult with hospitals and also with aging services providers. And it occurs to me these separate entities need to start talking to each other. Because as hospitals theoretically switch from a sickness to a wellness model and coordinate care throughout the continuum, aging services providers will be in some way part of the hospital's accountable care organization.

So let's start with the obvious one -- skilled nursing and rehabilitation facilities. Hospitals are using these facilities more and more. Referral to them and the experience a patient has in them is reflective of the hospital. In turn, that impacts the hospital's image and marketing. So it might be wise to pay attention to news in that industry.

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For example, the HHS Office of Inspector General issued a report that concludes that more than 90 percent of nursing homes employ one or more people who have been convicted of at least one crime. Five percent of all nursing home employees working in 92 percent of facilities have at least one criminal conviction.

This study was big news, so you can expect that consumer will ask if and how providers conduct background checks and whether any staff members have ever been convicted of a crime.

You need to ask those questions too on behalf of your patients.

Gov. Rick Scott (R) fired the director of Florida's long-term care ombudsman program, Brian Lee, suddenly on Feb. 7. Lee, in the position for seven years, had recently asked Florida's 677 nursing homes to submit detailed information regarding ownership stakes. Against that backdrop, two large real estate deals were transacted on Feb. 28. Health Care REIT bought the real estate of Genesis HealthCare for $2.4 billion. Ventas agreed to buy Nationwide Health Properties for about $5.7 billion in stock, forming the biggest healthcare real estate investment trust in the country.

The issue of nursing home ownership is important. The New York Times investigated the ownership of nursing homes in 2007 from a structural standpoint. They explored how ownership is sometimes structured in ways that separate real estate from operations and decentralize ownership across distinct sub-companies.

So, in essence, if there is litigation, it becomes hard to know who to sue and where to collect. Since then there have been studies that suggest care differs depending on for-profit versus not-for-profit status. Research by consumer advocates and labor union representatives indicate that staffing and quality decreased after private equity firms purchased nursing homes from national chains.

This is public knowledge and a savvy consumer is going to start asking about ownership and if it matters.

You need to ask those questions, too, on behalf of your patients.

The National Quality Forum (NQF) came out in support of 21 measures to be used to care for both long-term nursing home residents and short-stay patients. These measures will be included in the Centers for Medicare & Medicaid Services' Nursing Home Compare website. These measures are designed to help consumers "better understand and compare quality of care when selecting nursing homes," according to Dr. David Gifford, who co-chaired NQF's Steering Committee on Nursing Homes while serving as Director of the Rhode Island State Department of Health. Consumers are asking questions and starting to understand quality metrics around nursing homes.

You also need to ask those questions on behalf of your patients.

Now to a related industry -- homecare. The American Association for Homecare claims the competitive bidding process the Medicare program recently introduced to the procurement of durable medical equipment is not working. The AAH suggests it has been plagued with problems, including difficulties finding local providers, reduced choices and quality and confusion regarding home-based healthcare that may be contributing to longer hospital stays. An official with the Florida Alliance of Home Care Services claimed that patients who had routine home healthcare needs were being sent to hospital emergency rooms because of this.

Issues in aging services are impacting care on the hospital side. So if nothing else, start reading about those issues by keeping up with the associations that represent that industry segment. And keep you ear to the ground about the providers in your area as well. Talk to your discharge planners, social workers, and pastoral care staff and get the real story. The blurring of healthcare services and responsibilities has image and revenue implications for all providers. So be careful of the bedfellows you keep.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities. He is also author of the expert guide in Assisted Living.

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