Nonprofits vs. Symphony: Post-Acute Battle in Chicagoland

The word “Symphony” is not music to the ears of nonprofit post-acute skilled care providers in the Chicago area.

That’s because the Chicago-based, for-profit post-acute care operator poses major competition for several not-for-profits in Chicagoland. There, Symphony operates most of its 28 properties, including some newer buildings that are state-of-the art.

Now, though, not-for-profit post-acute providers have a plan to go up against the “Symphonies” of the world, and win.

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There’s been discussion among not-for-profit post-acute care providers about creating a network to compete with for-profit post-acute care providers, Stephen Johnson, a managing director at Chicago-based speciality investment bank Ziegler, explained during a presentation at the recent LeadingAge Illinois 2017 Meeting and Exposition in Chicago.

Some of Ziegler’s post-acute clients are having trouble maintaining high occupancy, Johnson explained. Anecdotally, he and his colleagues have heard that these non-profit clients are often “bumping up against” Symphony buildings in their markets—and that’s messing up their existing hospital referral pipelines.

“Hospital systems find it easier just to go to Symphony,” Johnson said. “They know Symphony, Symphony has data, technology—they’ve invested in those sorts of things.”

For-profits like Symphony are able to capture patients because it’s easier for hospitals to discharge “to one location that they know and put patients in a facility that they’re familiar with,” Johnson added.

Facing these tough circumstances, not-for-profit post-acute providers are trying to find creative ways to compete with for-profits, Johnson told Skilled Nursing News. In response, the LeadingAge Illinois board has approved the creation of “a separate LLC” that will act as a not-for-profit provider network, LeadingAge Illinois President and CEO Karen Messer told SNN.

LeadingAge Illinois is “in the very, very early stages” of forming the new network, Messer added, but there are already high hopes for its success.

“Establishing their own not-for-profit provider network is a way of getting scale on the not-for-profit side to compete with some of the organizations that have scale on the for-profit side,” Johnson explained.

Post-acute tetherball

The network will likely involve data collection and analysis, Messer and Johnson agreed.

“They’d have to have data, and proven measured outcomes, and all the things you would expect of a for-profit organization that is able to negotiate on scale with a health system,” Johnson told SNN.

The new network won’t just include post-acute providers, either.

“Our vision is that it will be a pre-acute and a post-acute type of network,” Messer said. “It will span senior services across the continuum.”

At this point, the not-for-profit provider network is only a LeadingAge Illinois initiative, though other networks have been set up in other LeadingAge partner states, Messer said.

In the meantime, until the new network is underway, not-for-profit providers in Illinois will have to cope with for-profit competition in other ways. Perhaps encouragingly, hospitals that started referring patients to Symphony facilities have begun referring to not-for-profits once again because they “weren’t totally satisfied with the care” patients received at Symphony, Johnson has heard.

“We’re starting to see that happen,” he said at LeadingAge Illinois.

The prospect of shiny, for-profit competition can be daunting to longstanding, not-for-profit providers. In reality, however, quality not-for-profits shouldn’t worry too much.

“Maintain your quality of care over time, and I think you’ll begin to see the ball come back around,” Johnson concluded.

Symphony, meanwhile, stands by the quality of care it provides.

“Symphony Post Acute Network strives to provide quality care at a consistently high level,” Symphony Chief Nursing Officer Donna Scrozynski said in a statement to SNN.

Symphony is a preferred partner in multiple accountable care organizations and bundled payment initiatives, and “consistently” produces outcomes that are better than necessary to be included in those partnerships, she added. She also cited other results, such as:

  • 28% of Symphony Post Acute Network member facilities were rated five stars in the latest Five Star Ratings published by the Centers for Medicare & Medicaid Services (CMS)
  • Hospital readmission rates have “consistently improved” even though Symphony serves high-acuity patients, including a “significant number” of dialysis patients
  • Annual Survey Inspection results are consistently better than national and state averages

“We will always strive to improve care and services for the best possible outcomes for our patients and ensure Symphony Post Acute Network member facilities remain quality providers of post acute services,” Scrozynski concluded.

Written by Mary Kate Nelson