Skilled Nursing Providers Can Still Break Into Narrow Networks

Skilled nursing providers frequently fret about the rise of narrow networks — the closed-off groups of high-performing nursing homes that hospitals have developed to ensure the best quality and reimbursement outcomes for their patients. But even the narrowest preferred skilled nursing networks have gaps that smart providers can fill, as long as they know where to look.

Located in Chicago’s southern suburbs, Riverside Healthcare provides a range of services, from acute care at its hospital in Kankakee, Ill. to primary-care physicians’ offices to skilled nursing and independent senior living options. As a result, it already has a tight pipeline of patients that travel from the acute to post-acute settings: According to chief nursing officer Michael Mutterer, about 85% of residents at Riverside’s 162-bed skilled facility come from within the network. Still, speaking at the annual Senior Care Marketing Sales Summit (SMASH) in Rosemont, Ill. on Wednesday, Mutterer said he still devotes energy to finding partners to pick up the rest of the slack.

“Even if 85% of my business is going internally, that’s still 15% of the business that’s going somewhere outside of my network,” Mutterer said during a panel discussion, adding that Riverside’s core market includes at least five other skilled nursing facilities and “countless” home health agencies.

Part of the opportunity for providers to capture that 15% of patients can come through specialization.

“We can’t be all things to all people,” Mutterer said of his group’s operations.

In fact, the idea of a “narrow network” can be something of a misnomer. A recent study of hospital networks found that some had more than 350 individual SNF partners over an 18-month span, and individual patients still retain the right to receive post-acute care wherever they want — with proximity to family or familiarity with a specific facility often playing as much of a role as star ratings and doctors’ recommendations.

“Where you get noise in the network is people go back to their homes, and that could be 90 miles away, and so you get a lot of what I would characterize as onesies-twosies that make it seem like thaey have a quote-unquote large network,” independent health care consultant Brian Fuller told Skilled Nursing News last month.

Pain points

Moderator Daniel Schwartz, chief operating officer of home health provider Almost Family, said post-acute operators should familiarize themselves with the specific “pain points” that all of the hospitals in their region experience on a daily basis. Almost Family, for instance, used the American Hospital Directory to discover that a major hospital in a specific Florida market was having issues with communication and post-discharge patient satisfaction — intelligence that helped the company inform its strategy in the region.

For Riverside, dual-eligibles — residents that qualify for both Medicare and Medicaid benefits — represent one of those pain points. The provider can care for these patients for 20 days, but only have a limited number of public-aid beds for residents that require inpatient skilled services for longer periods of time. When discussing admissions of dual-eligible patients, Mutterer said, Riverside employees give them the option of either going to the Riverside SNF with the knowledge that they may have to move, or entering a different facility that has the capacity to hold them for more than 20 days.

“We keep our other post-acute care partners very busy,” Mutterer said.

Once skilled nursing leaders have identified a potential partner’s pain points, they need to demonstrate how their particular company is best positioned to ease the problems. Two decades ago, executives at hospitals wouldn’t necessarily be receptive to these kinds of pitches, Mutterer said, but with new payment models placing an even greater emphasis on reducing readmissions, the doors to the acute care C-suites have opened.

But that also doesn’t mean that skilled nursing facilities should focus solely on the executives. Almost Family uses an approach they call “air and ground,” with the former representing the C-level staff — and the latter referring to the mid-level decision makers that may have more ground-level knowledge of their organization’s strengths and weaknesses. More and more acute-care providers have been establishing these working groups, Schwartz said, and getting a piece of a preferred network’s outside referrals could rest on identifying their key players.

“You’ve got to take the risk and pick up the phone and try to make those connections with your partnering hospitals, whether you’re in network or out,” Mutterer said.

Written by Alex Spanko

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Alex Spanko
Alex covers the long-term health care industry for Aging Media Network, with a specific interest in the intersection of finance and policy. Outside of work, he reads nonfiction, experiments in the kitchen, enjoys pretty much any type of whiskey or scotch, and yells at Mets games — often all at the same time.

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