A privately operated skilled nursing facility for veterans in Utah ranked number one in the country* for rehospitalization rates — a feat its administrator ascribes to both smart staffing and a prime location.

The Southern Utah Veterans Home tied for the number-one spot in a recent ranking of all 15,421 nursing homes in the United States by rehopitalizations, based on preliminary data released by the Centers for Medicare & Medicaid Services (CMS) through its CASPER system.

The exact data was confidential, according to officials at the home, but the public Nursing Home Compare website reveals a short-stay rehospitalization rate of 11.5%, below the Utah average of 16.6% and the national average of 22.4%. The Southern Utah Veterans Home also has an overall quality rating of five stars.

The rehospitalization metric has taken on increased importance under the SNF Value-Based Purchasing (VBP) program, under which providers will automatically lose 2% of their total Medicare reimbursements — a slice of money they can earn back by hitting certain readmission benchmarks.

According to building administrator Jerry Olson, employing physicians who understand how essential that statistic has become to SNFs has been influential in the building’s success.

“The physician needs to share a sense of urgency about reducing those rehospitalizations, because lots of times, it’s easier for the physician to just say: I’ll send them to the emergency room,” Olson told Skilled Nursing News. “But if the physician really, really cares and has that shared objective of reducing rehospitaliztions, then there are things that can be done.” 

Olson and the rest of the staff at the Southern Utah Veterans Home work for Avalon Health Care Group, a Salt Lake City-based operator that runs the state’s four veterans’ facilities on behalf of the state government. The state system is separate from the Department of Veterans Affairs, Olson said, though Avalon does receive funding from the VA and other supplemental sources.

Southern Utah’s location outside of the medium-sized city of St. George gives it the strategic advantage of being near the Rocky Vista University College of Osteopathic Medicine, which sends students to the facility under a teaching arrangement. But Olson emphasized that even providers without a built-in medical student population can still find ways to bring doctors into the SNF in an attempt to identify and control issues before a resident requires acute care.

“We’re lucky to be near a medical school, but it doesn’t have to be a medical school. It can be any doctors,” Olson said. “You just have to get out in your community and find a doctor that’s willing to partner with you. I see it as a business opportunity for a physician who can really see the vision of it.”

In addition, Avalon has worked to develop a tight network of home health partners, primarily by firmly laying out management’s expectations. The building’s management invited all of the home health providers in the area for a luncheon, in which Avalon laid out exactly the requirements they’d need to meet in order to become a preferred referral source: a five-star rating from CMS, as well as the ability to come in and meet every resident in person prior to discharge.

In those meetings, Avalon brings together the home health agency, the patient’s family, and its own internal handoff team to identify any special circumstances or risks for each particular case.

“We’re all in the same room, so there’s no misunderstandings about what the plan of care is or the goals of care upon discharge,” Olson said. “That’s worked really well for us.”

Olson and Avalon also developed a palliative care program that incorporates an element of long-term care planning, hiring a retired military chaplain with a degree in marriage and family therapy to help residents work through end-of-life decisions.

“Most nursing facilities, at least in this region of the country, don’t have their own chaplains,” Olson said. “They kind of count on hospice companies to provide chaplaincy services, [and] a lot of our veterans, they’re afraid of the word hospice. They don’t want to talk to anybody from a hospice.”

Allowing residents to speak with a trained therapist about how they want to spend the end of their lives in turn encourages them to draw up advance directives, another key factor in ensuring that all hospitalizations are necessary and in line with each patient’s wishes.

“That way they don’t have to insist on being rushed to the hospital every time they have a little cough,” Olson said.

*Editor’s Note: When the Centers for Medicare & Medicaid Services (CMS) publicly released its full ranking of nursing homes under the VBP program, Southern Utah Veterans Home was revealed to be one of many properties across the country that tied for the number-one ranking. That still places the facility and Avalon among the very top providers in the  United States, though for the record, it shares the honor with 440 out of the more than 15,000 ranked nursing homes.

Written by Alex Spanko