Data has quickly become king in the increasingly challenging skilled nursing world, but the question of how different providers along the care continuum can use that data remains a sticking point.
Upgrading a building’s electronic health record (EHR) distribution system from fax machines to cloud data solutions is the first step. The information, however, doesn’t mean much if the hospital or the home health agency can’t see it, and with any given network potentially using multiple systems, the chance for roadblocks is high.
In his five years as chief information officer at Consulate Health Care, Mark Crandall has seen the interoperability problem only worsen — while the incentive to share data to win under new payment models has only heightened.
“It’s important for us to be able to seamlessly interchange data with providers up and downstream, and it may sound easy, but it really has been very challenging,” Crandall told SNN.
At more than 140 buildings across 12 states, Consulate ranks as the nation’s sixth-largest nursing home provider, and the biggest in the elder care hub of Florida. But even today, Crandall said, some properties in the Consulate network still use fax machines — technology that is increasingly unrecognizable to the next generation of physicians and nurses — to share resident health care data with other providers.
“I understand that that was the way it’s been done, but when you have electronic health records that have really penetrated most of the market by this time, it doesn’t make sense to not partner with technology companies that can translate from one provider to another in a common language,” Crandall said.
Pressure to track
That pressure to streamline communication drove Consulate’s recently announced partnership with Collective Medical, a Cottonwood, Utah-based provider of software that follows patients from the hospital to the post-acute facility to home. Participating providers in Collective Medical’s network have access to information about individual patients regardless of their location.
For instance, if a former skilled nursing resident shows up at an emergency room equipped with the Collective Medical software, the SNF operator will receive an instant notification — allowing staff to potentially send the patient back to the SNF instead of admitting him or her to the hospital. The data sharing also works in the opposite direction: When an acute-care facility discharges a resident to a SNF within the data network, staff at the nursing home will have access to all of his or her health data immediately upon admission.
“We can make sure that everyone who comes into contact with that patient understands the care plan, understands what has been provided, so that they are given the care in the best setting for them,” Crandall said.
Patient-tracking software isn’t just a way to remove ancient telecom equipment from skilled nursing facilities. Operators face a variety of reimbursement dangers when residents return to the hospital within 30 days of their SNF stays, including potential penalties under the SNF Value-Based Purchasing (VBP) program and hits to their Five-Star Quality Rating System statistics. [
In addition, under new models such as bundled payments and accountable care organizations (ACOs), SNFs could find themselves on the hook for any penalties that their downstream or upstream partners receive for costly admissions — the patient fate that the Centers for Medicare & Medicaid Services (CMS) has essentially structured its entire payment system around avoiding.
Early data about the efficacy of programs such as Collective Medical, as well as similar products from firms like PatientPing, have been positive. Marquis Companies, a skilled nursing operator in the Pacific Northwest, saw a 60% reduction in hospital readmissions in just a few months using the Collective Medical technology on a three-building pilot basis. That reduction was primarily the result of Marquis being able to intervene when a discharged resident showed up at an emergency room.
“You don’t need to readmit them,” Marquis director of data analytics Anthony Laflen told SNN last year. “Send them to us.”
As with all health care data systems, some interoperability challenges remain: Hospitals still need to be on the Collective Medical system in order to generate alerts for Consulate employees. In Virginia, all of the SNF provider’s hospital partners use the system, Crandall said, though the two companies are still in the process of trying to build out a network in Consulate’s home state of Florida.
Consulate’s massive presence in the Sunshine State played a role in the initial talks between the two companies in the fall of last year, Crandall said; while the skilled nursing provider wanted to boost its data-sharing capabilities, Collective Medical saw an opportunity to increase its profile in the lucrative Florida market.
“We’re the largest senior health care provider in the state of Florida, and so the more we can tell this story of interoperability, the more providers will jump on board in that network, and the easier time we will have as far as tracking that patient through the continuum,” Crandall said.
In addition, Consulate frames the data partnership as a way to market its overall brand to potential residents — while also convincing hospitals that its buildings can indeed provide the kind of higher-acuity services that can help avoid acute admissions.
“There’s keeping patients comfortable in our care centers once they arrive, and making sure that the community understands the level of service that we can provide in our care centers and our community,” Crandall said.