Specialty ‘SNFist’ Doctors Could Be Key to Landing Referral Partnerships

As the nursing home industry roils with changes ranging from the demographic to the governmental, one Illinois skilled nursing facility has put its focus on short-term rehab and transitional care patients.

As a result, it depends more heavily on patient volume than most SNFs, necessitating as many referral sources as possible. And as management pursues those partnerships, the SNFist program plays a key role at Transitional Care of Arlington Heights, Ill.

Under the system physicians and nurse practitioners who specialize in skilled nursing patients make routine rounds at the suburban facility, and leaders say the benefits are both clinical and financial.


“In a traditional model, a physician might be balancing duties in an office, maybe even in a hospital, along with patients that may go to skilled nursing, and what it does it divides their time between the multiple settings,” Charles Ross, chief strategy officer at Transitional Care Management, told Skilled Nursing News. “Often, they’re not frequently seeing their patients. With the SNFist model, the physicians are focusing on our setting, and they’re catching changes in condition between them and their nurse practitioners. They also do a really nice handoff to the primary-care physician prior to discharge home, or whatever that next level of care is.”

The Arlington Heights location — located about 30 miles northwest of downtown Chicago — has 120 certified beds, with an average payor mix of 64% Medicare, 33% insurance, and 3% private-pay, he told SNN. The typical length of stay is about two weeks, and that makes patient volume absolutely crucial: The facility has seen up to 30 different referral sources in a month, and has three liaisons covering the Chicagoland market to capture patients and keep an eye out for partnerships.

One of the key ingredients is maintaining preferred provider status with the local hospitals and physician groups — and that can tie into the facility’s SNFist model. Transitional Care of Arlington Heights recently earned a spot in the post-acute network of hospital operator Advocate Health Care; as part of that arrangement, an Advocate-employed physician and nurse practitioner visit the facility anywhere from five to seven days a week.


Another referral source, Northwest Community Hospital in Arlington Heights, has  a physician group that employs a physician and a NP who are at the Transitional Care facility approximately five days a week — along with a once weekly visit from a cardiac NP, according to chief clinical officer Michelle Stuercke.

Transitional Care also has two independent physicians who are there four to five and five to seven days a week, in addition to nurse practitioners who are there five to seven days a week depending on volume and admission.

Though sometimes community physicians will come in to follow a patient or check in on someone they’ve been seeing for a long time, about 95% of the residents in the Arlington Heights facility are covered by one of the SNFist groups, Ross told SNN.

The partnership effect also works the other way around: Having the proper physician coverage is also essential for getting into the preferred provider networks for the local hospitals. Transitional Care Management was recently accepted into Northwestern Medicine’s preferred provider network, an arrangement that came with “some specific requirements as far as physician coverage, that we’ve got,” Ross told SNN.

Chicago-based Rush University Medical Center is also launching a preferred provider network in September, and Transitional Care won a request for proposals to be one of its providers. Each hospital partner has its own requirements for a model of care in SNFs; some, like Advocate and Northwest Community, will want to have control over the physician part of the program, while Transitional Care can work with models that require it to use one of its other SNFists, Ross said.

Ross and Stuercke emphasized that while the exact thresholds for partnership vary, the metrics generally don’t differ much. Readmission rates, length of stay, and overall quality as rated by the Centers for Medicare & Medicaid Services (CMS) were common factors.

Another, less obvious, factor was customer service, something that Advocate in particular took a hard look at, Stuercke said.

“It’s great that you have five stars, it’s great that you have great outcomes,” she said. “But if the customer isn’t happy, it doesn’t really matter. So they put a huge focus also on consumer satisfaction.”

Since hospitals and physician groups are looking for the metrics that will help them perform better as a system, being able to deliver on all the metrics is essential — as is demonstrating that delivery.

“My advice to anyone looking to be part of a network is looking at the multiple points of contact in a hospital or health system and making sure that we’re delivering what those various people are looking for,” Ross said. “And communicating to them that we’re delivering it.”

Written by Maggie Flynn

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