Skilled nursing operators shouldn’t be scared of losing market share to the shift to home trend, including SNF-at-home – at least not in the near-term.
Instead, operators need to look at shifts to home-based care as an opportunity to diversify business lines in the future, as patient preference, Medicare Advantage (MA) plans and technology advancements make SNF-at-home an increasingly viable option.
Currently, the care setting is a “subset of a subset,” according to Fred Bentley, managing director at DC-based consulting firm ATI Advisory. Bentley and Drake Jarman, senior vice president of growth and development for Nashville-based Contessa Health, spoke about the shift to home trend during a panel at Skilled Nursing News’ RETHINK event.
Contessa, an Amedisys company, provides hospital-level medical treatment into the home through care models such as recovery care at home, rehabilitation care at home and palliative care at home.
Disqualifiers – if a patient is on a ventilator, needs a three-person assist, or lives outside of a service area, mainly – leaves only 3-5% of patients eligible for the program, Jarman said.
About 18% of Contessa’s patients are clinically eligible to receive SNF-at-home services.
“This is very early days here. It’s a very small subset of the SNF patients, specifically,” Jarman said. “The adage has been it’s the first inning of the at home movement. I would disagree with that. I don’t think we’ve even reported for spring training.”
SNF-at-home and the silver tsunami
Still, there’s a rising tide that will “lift all boats,” Jarman said, in the form of aging baby boomers.
In order to scale, he added, long-term care will really need the full continuum, which includes SNF-at-home. For nursing home operators, now is the time to partner with health systems and home health companies to be that in-network facility or to build out their SNF-at-home program, respectively.
“It’s a very large iceberg that is coming down the pike. You guys do need to be thinking about this. You are in a great place to be thinking about this,” added Jarman. “If you are a high quality SNF operator and you’re partnered with high quality, in demand health systems in one way or another, you’re always going to have a seat at the table.”
SNF-at-home involvement may help with public perception too, Bentley said, referring to headline risk during and even before the pandemic, and the current administration’s antagonism toward the industry.
“SNFs don’t typically have a great reputation or are not viewed particularly favorably by Medicare Advantage plans or health systems,” Bentley said. “There is a sense that it is an industry that has thrived on Medicare Part A reimbursement and there are big questions around, what is the value that SNFs deliver?”
A home-based business line shows the public and other parts of the care continuum that SNFs have this capability, they have the partnerships and want to think about SNF-at-home differently.
While Medicare FFS currently doesn’t cover SNF-at-home, Bentley expects that to happen – but not any time soon.
“This is a chance to not only capitalize on new business, but also portray yourself in a new light as we’re trying to find the most clinically effective best setting of care for patients, whether it’s in our facilities, or we’re in their homes – we can meet the patient,” Bentley said. “We are where they need us to be.”
Technology as a driver
Technological advances in the last several years have made a tremendous difference in accelerating the shift to home trend, Bentley and Jarman said.
As therapy and other less hands-on services can be done virtually, SNF-at-home businesses have a centralized analytics platform and a team tracking patients.
An analytics team flags and addresses issues that arise, an acute episode or otherwise, Bentley said.
“We talk about what’s reimbursed and what’s not reimbursed, and meanwhile, the technology has advanced quite dramatically,” he said. “A lot of the success that Contessa and other groups have had is very much based on technological advances.”
Contessa’s SNF-at-home model currently has a 90%-plus satisfaction score and a 27% reduction in readmissions, Jarman said.
“We assume risk, we give the health plan a discount. We are going to reduce costs, we are going to improve outcomes or we’re going to be out of business,” added Jarman.
One unintended challenge of what companies like Contessa are trying to do: the burden placed on family members involved in SNF-at-home.
Coordinating home care, Bentley said, is sometimes an underrecognized barrier to SNF-at-home as scheduling and transfer of care can fall through the cracks.
SNF-at-home as staffing pull
While home health agencies aren’t going “gangbusters” with recruiting and retaining staff, Bentley did say his home health clients are having more success in a very tough market, bringing nurses in to help stand up the SNF-at-home model.
Higher payments and the idea that nurses will be part of something new are the two main draws, he added.
“This new opportunity is really giving them a new lease on life and bringing them back into the fold,” Bentley said. “They’re not going from room-to-room but really home-to-home, less visits in a day, more meaningful interactions where you can really be a part of that healing process for the patient.”
When nurses are brought into Contessa, they aren’t put into a little SNF-at-home box, Jarman was quick to point out. They may start as a SNF-at-home nurse, but then deliver home-based care for the entire continuum, from primary care to acute care to SNF-at-home.
“It’s a much more fluid model than I think a lot of us are accustomed to thinking about,” noted Jarman.
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