As PDPM Looms, Luxury-Focused Ignite Expands ‘Medical Resort’ Model

With a recent grand opening in Kansas City, Ignite Medical Resorts is betting that short-term rehab still can be a winner — even if the reimbursement math will become trickier under the new Medicare payment system next year.

“At the end of the day, many people can build a nice facility,” Ignite co-founder and CEO Tim Fields told Skilled Nursing News. “It’s the care and the service that matter most.”

The 90-bed Ignite Medical Resorts — Kansas City, opened earlier this month, marks the second facility for the Niles, Ill.-based provider. The company is planning to add an additional four to five buildings over the next two years, Fields told SNN.

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Ignite’s pipeline includes a project that’s just broken ground in Milwaukee; two proposed buildings in Kansas City and McHenry, Ill., both of which are scheduled for groundbreaking next spring; and an existing building that the company plans to acquire in Kansas City.

Fields, who served as the president of Symphony Post Acute Network before founding Ignite, had tested out his “super SNF” concept at that company. While at Symphony, he defined the concept as a building that combines medically complex care with “high-end hospitality.” Fields was intrigued enough by the model that he decided to co-found Ignite in 2017 with the goal of creating a culture built around the concept, he told SNN.

In addition to the recently opened Kansas City facility, Ignite has a 167-bed building, Avanti, located in the Chicago suburb of Niles, Ill. That facility had been owned by Ignite co-founder Barry Carr and became an Ignite facility this year. It was that facility’s success in an “advanced market” for bundled payments, alternative payment models, and other new reimbursement structures that convinced Fields that the company’s focus on luxury and rapid rehabilitation was viable. For the most recent quarter, Avanti had an average length of stay of 13.8 days, with a readmission rate of 4%, in Advocate Healthcare’s accountable care organization (ACO), according to Fields.

Those metrics have become vital under new payment models and the rise of Medicare Advantage plans, and Ignite looks to build on that success in Kansas City with a focus on orthopedic, cardiac, pulmonary, and stroke rehabilitation as its medical specialties, Fields told SNN.

“I think most people would tell you they focus on that,” he said. “I think the level we are trying to get to is the more advanced level of [those areas].”

The “rapid rehabilitation” model is how Ignite hopes to attract residents, Fields said, and as a result, the company employs all therapists — physical, occupational, or speech — rather than contracting them from a third party.

“I never understood, in a higher-intensity rehab model, why you would outsource your core competency,” Fields said. “I think it also prepares us for PDPM.”

The new Patient-Driven Payment Model (PDPM) will take effect on October 1, 2019, and it’s expected to have a significant impact on the world of rehab. Therapy companies will have to change their business models significantly, several experts told SNN earlier this year, as providers are incentivized to take on more medically complex patients and the volume of services provided no longer drives reimbursement. In this environment, having more control over therapy and integrating it more closely with nursing care will put Ignite in a good position under the new model, Fields told SNN.

It also allows Ignite to provide therapy based on patient need rather than on cost concerns.

“I think one of the benefits of providing in-house therapy is we can treat what the patient needs are, rather than the minutes that are dictated,” he told SNN. “I don’t have to pay more for that therapist to give 60 minutes of physical therapy rather than 30. Because they’re an employee of mine, I’m paying the same fixed cost, no matter what.”

For the medical complexity aspect of the new model, Ignite’s capacity to take on such patients will be crucial — both under PDPM and for the company’s success more generally. Fields cited the company’s ability to care for high-acuity patients as a reason why it was able to develop strong financial and clinical relationships with hospitals and health systems in the Chicago area, including Advocate.

The market is a bit different in Kansas City, Fields said. ACOs, bundled payments, and other alternative payment models haven’t advanced as far in this market as they have in the Chicagoland area.

“I think the biggest opportunity for us in Kansas City is with the managed care plans,” he told SNN. “They are overutilizing long-term acute care and acute rehab, and … we’ve had some great conversations with the big managed care players down here about developing true partnerships, risk-based partnerships.”

To help boost its capacity to take on clinically complex patients, Ignite has focused on technology, partnering with the contact-free, continuous monitoring technology company EarlySense to monitor resident vital signs, and building a hotel-style platform that allows patients to request items from their bedsides via touchscreen. Ignite also has an in-house pharmacy and an onsite lab, aimed at making the medication management and discharge planning processes more efficient.

Offering these services internally isn’t much more expensive than outsourcing would be, Fields said, and the boost in alignment with payers and referral sources makes the investment worthwhile.

“At the end of the day, my costs for taking care of patients might be more expensive than my neighbor down the street,” he said. “But if I get more patients from the hospital … and I can recruit better employees, at the end of the day, it’s worth it. I’m still able to make a margin, and at the end of the day, it’s not about making a profit. It’s about doing the right thing.”

Written by Maggie Flynn

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