Skilled nursing facilities may have already seen the bottom of the industry’s historic COVID-19-driven occupancy drop, allowing operators to turn their attention in the months ahead to the next key challenge: financial recovery.
Operators must recoup the financial losses associated with COVID-19, offset increased costs and successfully address the reality of vast staff burnout.
One avenue to financial recovery seems to be admitting higher-acuity residents, since care for these individuals returns higher per diem rates under the Patient-Driven Payment Model (PDPM), often in multiple payment categories. In addition, hospitals are eager to discharge low-risk patients directly to home and are looking to their SNF partners to support a higher level of care.
Savvy providers have taken this into account and have started transitioning their care model to focus on higher-acuity residents.
Yet for many SNFs, this transition poses significant challenges, which the pandemic’s impact has only exacerbated. Here is a look at how tele-hospitalists can help solve three of the biggest challenges SNFs face when building back census with higher-acuity residents.
Nursing staff need support to work with these patients
Nursing home associates often report they lack the confidence or skills to care for patients with complex medical needs. After years of focusing on healthier residents, veteran nurses may need additional training, while less experienced associates may have little experience to draw from when it comes to caring for very sick individuals.
Giving nurses easy access to an engaged physician via telemedicine is a cost-effective way to support these essential workers as they build skills for higher-acuity care. When a physician can collaboratively see and examine the patient by video, the attending nurse is empowered to treat the higher-acuity resident’s clinical needs with more confidence.
Physician support can reduce anxiety for onsite staff, especially night-shift nurses, and build camaraderie within the health care team. Another added benefit is the opportunity for nurses to build new clinical skills in partnership with an engaged physician.
“With tele-hospitalists, our night-shift nurses feel supported now,” says Courtney Galindo, ADON, Kern River Transitional Care out of Bakersfield, California. “When they need extra eyes on a resident, help with orders, or just another clinical perspective from the doctor, the tele-hospitalists are there to help.”
Higher-acuity residents can lead to more returns to the hospital
Keeping hospital readmissions low is essential for both patient outcomes and quality scores.
Accepting discharged patients with complicated medical conditions potentially opens the door for more returns to acute, interrupted stays and value-based penalties, all of which can negate the financial gains from higher-acuity case-mix groups.
To avoid these losses, facilities must proactively identify residents at high risk for readmission and create a plan of care that includes added physician engagement. Additionally, the care team must strive to identify changes in condition quickly and use “treat in place” protocols whenever possible, even at night.
“Operational guidelines that include clinical care plans for high-risk residents ensure that tele-hospitalists are completely aligned with the nursing staff on the capabilities in the building to care for that resident population,” says Dr. Brian Carpenter, National Medical Director of Telemedicine at telemedicine leader Sound Physicians.
Too often, in the middle of the night, when a resident experiences a change in condition, a trip to the emergency room becomes the default solution. With telemedicine, a physician can see and treat the patient at the bedside in a matter of minutes, often eliminating the need for an ambulance.
With a tele-hospitalist on shift overnight, the onsite staff has a clinical partner to monitor higher-acuity residents, manage changes in condition, and deliver appropriate interventions. If the physician determines that the patient needs to return to the hospital, they can manage the transfer remotely, improve care, and facilitate a timely return to the building.
In fact, after implementing a tele-hospitalist program to support nursing staff, Green Village Skilled Nursing & Rehabilitation, a 72-bed SNF in Akron, Ohio, saw its 30-day hospital readmission rate drop from over 25% to an average of 8% in the first seven months of the program. SNFs across the country have experienced similar results.
Staffing continues to be a challenge, with significant burnout
Nationwide, burnout is impacting health care workers across all specialties and settings.
Staffing was already a problem before COVID, with a new study from Health Affairs showing turnover at a median rate of 94% in 2017 and 2018. Nursing homes have been disproportionately impacted by the pandemic, with higher mortality rates and fewer allocated resources than their acute care peers.
As a result, recruiting, staffing and maintaining qualified workers for skilled nursing and long-term care facilities has become increasingly difficult. Providing a supportive and empowering environment for the care team, especially those who work after-hours, is essential.
Night-shift nurses are often the most vulnerable, working alone or in small teams with no physician on shift. Nurses report hesitating to wake an on-call physician in the middle of the night. Delays in care or lack of physician engagement can result in an unnecessary transfer back to the hospital.
Leveraging a tele-hospitalist group for on-shift coverage gives night-shift nurses immediate access to a physician who can attend to the patient via video technology within minutes, reducing medical errors and avoidable hospital readmissions.
“When my nurses see a change in a resident’s condition, they can now quickly pick up their iPad and digital stethoscope, hit a button, and a physician is there to take care of any of our patients,” says Stacy Zerban, administrator at Friendship Village in St. Louis.
Research before the COVID-19 pandemic showed that over 50% of physicians working in post-acute care in the United States experienced at least one symptom of burnout. Supporting SNF physicians and medical directors at night with staffed tele-hospitalist coverage reduces the negative impacts of being on-call 24/7. The chance to unplug and recharge when not on shift also helps minimize medical errors and has even been reported to improve care delivery at the bedside.
This tele-hospitalist support can result in increased reimbursement for the SNF community and improved quality of life for residents and the healthcare team.
This story is sponsored by Sound Physicians, a telemedicine leader connecting hospitalists and SNFs. To learn how they can bring better care to your residents, visit soundtelemedicine.com.