Post-acute and long-term care (PALTC) is critical to the healthcare continuum and an integral part of value-based care (VBC). This broad category includes skilled nursing facilities (SNFs), home health agencies, and their medical provider partners, who serve patients in their offices, the community, and SNFs. Value-based care (VBC) initiatives, such as 30-day readmission penalties, affect all these parties.
PALTC enhances quality of care by addressing unmet clinical, functional, and social needs, improving patient and family satisfaction, and reducing caregiver burden. However, today, the PALTC sector faces tremendous demands, resulting in daily fire drills to tackle pressing issues. Staffing shortages, regulatory compliance, financial pressures, and care coordination challenges nominate the landscape. These constant demands leave little time to prepare for the deeper integration of VBC into facilities, even though the impact of VBC is already evident.
Good news is on the horizon. By thoughtfully and systematically addressing today’s concerns, organizations can reduce the daily fire drills and empower their staff. This proactive approach will also set the foundation for flourishing in the era of VBC. Building robust systems that support the organization’s current needs and evolve as VBC reshapes the healthcare landscape is essential. Organizations can remain resilient and thrive amidst these changes by ensuring efficient, effective workflows, investing in supportive technology, fostering interdisciplinary teamwork, and forming strategic partnerships.
Industry Dynamics
The PALTC sector is influenced by several dynamic trends that present both challenges and opportunities:
- High Turnover Rates and Burnout: Exacerbated by the COVID-19 pandemic, the severe shortage of healthcare workers has created a significant challenge. High turnover rates and burnout among staff impact the quality and continuity of care, reduce staff morale, and add unnecessary recruiting and onboarding expenses.
- Regulatory Compliance: Stricter regulations and the need for compliance with various standards can be resource[1]intensive and challenging to manage.
- Technological Integration: Adopting and integrating new technologies, such as telehealth and electronic health records (EHRs), require significant investment and training.
- Financial Pressures: Decreased reimbursements and the need to manage costs while maintaining quality care put a financial strain on these organizations.
- Quality of Care: Ensuring high-quality care and patient outcomes and managing staff is a constant challenge.
- Patient Demographics: An aging population with complex health needs requires more specialized and intensive care, increasing the service demand.
- Coordination of Care: Effective communication and coordination among various healthcare providers and services are essential but often difficult to achieve.
Common VBC Metrics Value-based care emphasizes metrics that assess the quality and efficiency of care provided. Metrics commonly found in VBC agreements can include:
- Readmission Rates: Tracking the rate at which patients are readmitted to a hospital after discharge.
- Discharge to Home: The percentage of patients discharged to their home rather than another facility.
- Patient Satisfaction Scores: Measuring patient feedback on the quality of care received.
- Length of Stay: Monitoring patients’ average time in a facility.
- Functional Improvement: Assessing improvements in patients’ physical and cognitive functions.
- Mortality Rates: Tracking the number of deaths within a specific patient population.
- Total Cost of Care: Evaluating the overall cost of patient care.
Opportunities for Improvement
Addressing current challenges with thoughtful, actionable tactics helps manage immediate issues and aligns with Value-Based Care (VBC) metrics, ensuring your organization is prepared for the future of healthcare. Proactively tackling these areas can reduce stress and build a foundation for success in a VBC environment.
- Falls Prevention Programs
Aligns with VBC Metrics: Implementing fall prevention programs directly impacts patient safety and quality of care, which are critical VBC metrics.
Details:
- Develop and integrate comprehensive fall prevention protocols.
- Conduct regular staff training on fall prevention techniques.
- Perform IDT fall risk assessment, including detailed medication review.
- Perform environmental assessments to identify and mitigate fall hazards.
- Track and analyze fall incidents to continuously improve prevention strategies.
2. Reportable Events: Evaluate Trends and Identify Spikes
Aligns with VBC Metrics: Reducing reportable incidents improves patient safety and overall quality metrics.
Details:
- Regularly evaluate trends in reportable incidents and identify spikes.
- Conduct thorough chart reviews to understand the root causes of incidents.
- Implement targeted education and audits to address identified issues.
- Engage in Quality Assurance and Performance Improvement (QAPI) activities.
- Reducing reportable incidents frees up time to focus on other critical issues.
3. Resident Satisfaction: Listen to Residents
Aligns with VBC Metrics: High resident satisfaction scores contribute to positive patient satisfaction metrics and overall care quality.
Details:
- Create regular forums or surveys to gather resident feedback.
- Actively listen to residents’ concerns and promptly address them.
- Develop personalized care plans that incorporate residents’ preferences and needs.
- Enhance communication between staff and residents to build trust and improve satisfaction.
- Implement initiatives to improve residents’ daily experiences and overall quality of life.
4. Staff Satisfaction: Ensure Staff Feel Supported
Aligns with VBC Metrics: Satisfied staff are more likely to provide high-quality care, impacting patient outcomes and satisfaction metrics. Satisfied staff also equates to increased retention rates.
Details:
- Foster a supportive work environment with open communication channels, including staff accountability.
- Provide opportunities for professional development and career advancement.
- Implement measures to reduce burnout, such as flexible scheduling and mental health support.
- Recognize and reward staff achievements to boost morale and retention.
- Conduct regular staff satisfaction surveys and take action on feedback received.
5. Collaborate with Providers/Stakeholders
Aligns with VBC Metrics: Effective stakeholder collaboration ensures coordinated care, reduces readmissions, and improves discharges and patient outcomes.
Details:
- Develop and maintain strong relationships with key stakeholders, including hospitals, payors, home health agencies (HHAs), primary care providers (PCPs), and other partners. This includes establishing regular communication channels to discuss patient care and share information.
- Analyze data to understand when and why 30-day readmissions occur (e.g., at the facility or home).
- Engage relevant stakeholders in developing coordinated care plans. This must include discharge planning from admission. Involve patients and families in discharge planning and address social determinants of health (SDOH) that may be potential barriers to discharge.
- Educate patients and their families, including how to monitor their progress post[1]discharge and early identification changes in conditions warranting provider notification.
- Participate in joint training and education programs to align care practices.
6. Mock Surveys & Survey Tools and Internal Correction Plan
Aligns with VBC Metrics: Preparing for surveys and addressing compliance issues improves overall care quality and regulatory compliance.
Details:
- Conduct mock surveys to identify potential areas of improvement before actual surveys.
- Use survey tools to gather data and implement internal correction plans.
- Involve the entire facility in the survey preparation process, not just the nursing staff.
- Regularly review and update policies and procedures to ensure compliance with regulations.
- Implement corrective actions promptly and monitor their effectiveness over time.
7. Filing Grievances: Internal Cousin to the Reportable
Aligns with VBC Metrics: Effectively managing grievances prevents issues from escalating and improves patient and family satisfaction.
Details:
- Establish a straightforward process for filing and managing grievances.
- Encourage staff, residents, and families to report concerns without fear of retaliation.
- Investigate grievances thoroughly and take appropriate corrective actions.
- Communicate the resolution process to all parties involved to ensure transparency.
- Use grievance data to identify trends and implement preventive measures.
By adopting these tactics, your organization addresses immediate challenges, improves financial performance, and prepares for the deeper integration of VBC. These proactive measures align with key VBC metrics, ensuring your facility remains resilient and thrives in the evolving healthcare landscape.
Ramey Management Solutions empowers organizations to excel by harmonizing exceptional patient care with financial sustainability and regulatory compliance. RMS offers unparalleled operational efficiency and process improvement expertise, providing actionable solutions to reduce falls, reportable events, and grievances. Our commitment to robust operations, streamlined workflows, and sustained efficiency impacts staff and resident satisfaction, and regulatory compliance. Collaborating with RMS ensures you are well-prepared for today and the future of value-based care.
