Amid Changes, Downstream Partnerships Will Become Vital to Skilled Nursing Quality

Skilled nursing facilities are facing increasing pressure to be more aware of the full spectrum of a patient’s care, with the rise of value-based purchasing (VBP) programs and accountable care organizations. And when the new Patient-Driven Payment Model takes effect on October 1, that won’t be possible if individuals are making decisions on their own.

“There can be no more lead actors making solo decisions,” Susan Krall, vice president of strategic partnerships at Quality Rehab Management, said in a Thursday webinar hosted by Skilled Nursing News. “Bold delineation, recasting, character development, all need to be addressed as soon as possible, if not already.”

One of the major themes of the webinar was the importance of communication, both among the various players on the care continuum and among the various teams working inside the walls of a SNF. Directors of nursing (DONs) will have to start being more proactive, particularly with admission teams or hospital liaisons, to gather all the information about a patient that’s needed prior to admission to the SNF, Cherry Creek Nursing Center DON Betsy Hardy said on the webinar.


“They’re going to be the investigators, they’re going to be researchers,” she said. “So they’re going to have to be able to go and work with these hospital case managers and find out what was the reason they were there. What are the diagnoses they’re using in the hospital? We know for a fact that hospital communications with us in the SNF world are always delayed. We do not get the information quickly.”

But one set of relationships has a major bearing on quality: the downstream partners to which a SNF releases its patients after their stay is up.

“Part of the long-term survival of the skilled nursing facility is really going to be, I think, a unique combination of managing risk and taking on more risk,” Meredith Mull, vice president of business strategies at the Morrisville, Pa.-based management firm Continuing Care Solutions, said on the webinar. “Collectively, our discharge planning process should really take on a whole new look in order to be more effective, and I think rehab plays a real critical role in that.”


While partnerships are often associated with a SNF’s referral sources and the attempt to break into narrow or preferred networks, SNFs should be checking on the home health agencies and downstream providers to which they send their patients, Mull said. It’s advice that echoes the thoughts of Dycora Transitional Health and Living co-founder and CEO Julianne Williams, who argued in an interview with SNN that SNFs have to see themselves as a strong piece of the care continuum.

“Before, we would refer to home health,” she told SNN at the time. “Now, we refer to home health and we want to know what they’re doing. We know it doesn’t only affect us; it also affects the hospitals.”

In fact, SNFs could take some cues from their referral partners, Mull said on the webinar.

“Strategic downstream relationships … will give SNFs the flexibility in managing their PDPM length of stay, on top of their [value-based purchasing] return to hospital measures, their survey discharge planning requirements, and really just the overall cost of care,” she explained. “The keys are really going to be streamlining safe transition by vetting your partners, similar to what ACOs do with their post-acute relationships, right? And also owning more of the continuum that still falls within the realm of SNF expertise.”