Capacity issues and resulting loss of revenue, and concerns about adequate discharge plans prompted Summa Health System to develop an SNF care coordination network, explains Carolyn Holder, MSN, RN, GCNS-BC, manager of transitional care, resulting in improved patient care and reduced readmissions.
Why did we develop a care coordination network? In 2003, we were challenged with capacity issues. We were on bypass for quite a long time — 30 percent in 2002. We were losing revenue with those admissions being diverted to other competing hospitals, and there was a significant loss of revenue of $3 million in 2002. We were seeing unnecessary readmissions. We had concerns about the discharge planning process. Were we giving enough information when we sent patients out? We saw some barriers for that smooth transition to the next level of care. One example was that bed availability at the facility was delayed sometimes and recognizing whether there was a bed for that patient or not at the next level of care was an issue. When we first started, it took hours and sometimes up to a day to get a response. We looked at poor patient outcomes with readmissions to the acute care side.
We questioned if we should build our own network, and that was the first discussion that we had. We would need access to 119 beds. The major advantage to this plan is that we could manage the transitional care pieces and potentially decrease that length of stay in readmission. The major disadvantage was that we were an acute care setting, and we didn’t know anything about long-term care (LTC). Also, capital expenses for developing that level of care were quite significant. In addition, we were, and still are, over-bedded in the Summit County area as far as skilled nursing facility (SNF) care.
There was also the challenge of meeting physician expectations. If you have that level of care on-site in the hospital, you may see an appropriate ordering of medical treatments that would be very costly for a skilled facility level of care, because they are still seeing it as an extension of the acute care setting.
Should we lease the beds? Getting access to SNF beds was the next issue. There was financial risk and difficulty to manage something that is off-site. There was also the potential for decreased satisfaction if the facility is not located close to home. Our patient populations are looking for a facility that is close to their home. That is a major factor in the decisions they make to pursue or place that patient in a facility.
We decided that the solution was to form the care coordination network in 2003, with the overall objectives of decreasing fragmentation, length of stay, unnecessary readmissions and improving outcomes of care.
Accountable Care Strategies to Improve Hospital-SNF Care Transitions provides a look at how a health system-skilled nursing facility (SNF) network rallied 40 independent SNFs to form a network that elevated its hospital-to-SNF transfers of care, and reduced readmissions and length of stay for participants.