Broken Alignment Between Physicians, Nursing Homes Must Improve for Value-Based Care Era

The way physicians and nursing home organizations work together must improve, especially with value-based care continuing to grow in prominence among all care settings.

More specifically, C-suite executives, nursing staff and other leaders – from both the physician group side and nursing home operator end – must have a close partnership and aligned business strategies to best serve nearby communities, Dr. Arif Nazir, chief medical officer for Abode Care Partners, told Skilled Nursing News.

Abode is the primary care arm of BrightSpring Health Services, which also has a home and community-based health services provider base; long-term care pharmacy PharMerica is a subsidiary of BrightSpring as well. In his role with Abode, Nazir also does consulting work with large SNF providers Signature HealthCARE and American Senior Communities, among other SNF operators.


He was chief medical officer for Signature up until June 2022.

In his time at Signature and Abode, Nazir says he’s noticed a missing link between what physician leaders are used for now, and how they could be used to better align with creating quality care and maximizing reimbursement in nursing homes.

This conversation has been edited for length and clarity.


Let’s start with your time at Signature. How did it shape your thoughts on the role of physicians in the nursing home?

When I joined Signature, my eyes opened because I was supposed to lead more than 100 medical doctors and physicians. When I started looking at their conduct I was able to see that every physician, every practitioner basically has their own ways of providing care. I got a lot of experience working to understand what is the role of physician, medical director and nurse practitioner in the nursing home, and how they can really become an excellent partner to the frontline nursing teams.

How did you transfer that experience to BrightSpring?

The work I did at Signature, to understand how I could help nursing homes manage their physician leaders, was priceless. We didn’t want it to get lost. We are creating the world’s first chief medical officer [CMO] service line, where we are partnering with other teams now so that we can really show them what the role of a physician leader is and how we can manage physicians and medical directors better, and how we can build nurse practitioner programs.

How does the role of the physician in the nursing home affect reimbursement?

In the industry, everybody’s trying to scramble. It’s reactionary, because everybody knows that dollars are going to be in quality now, which is a great thing. Value-based care is our present and future. By 2030, as CMS has announced, every single patient’s reimbursement is going to come from value-based dollars. If you don’t provide quality, you’re not going to get paid.

Anybody who understands that fact, they are panicking. They’re asking, ‘Who’s our doctor, who’s our nurse practitioner,’ and [nursing home operators] realize that it’s not anybody they know or trust at this point. They finally are trying to get a handle on which physician they want to work with, everybody is trying to find these physician groups, but there aren’t many.

We just didn’t want to be a physician NP group, we wanted to become a C-suite partner to large organizations, to become true partners to them to build a whole organizational strategy. Care does not just come with putting an NP and a doctor in the building, it really comes from a culture of care. To do that, your C-suite and your frontline all have to be aligned with a quality-driven strategy. Our goal going forward is to partner with large organization chains, and bring to them an understanding of what quality really means from the medical services side.

How does this help with nurse workload?

Nurses just cannot do everything that has been expected of them. They need help from people who are aligned with them in their workflow. You need to work on a strategy where you have people that are coming to your building for medical services, and understand your challenge … Nursing homes need help from very well aligned leaders who understand their challenges and are ready to build programs that do not disrupt their workforce.

Unfortunately, a lot of [physician] groups are popping up left, right and center. They’re reactionary, they’ve never worked in nursing homes. A lot of them are coming from the acute care side.

Any other innovative work being done at Abode?

The most unique thing we are doing, it’s called Care Hub, an approach to addressing polypharmacy management. We have a relationship with one of the largest pharmacies – BrightSpring also owns PharMerica. We have made it an absolute priority to figure out how consultant pharmacists and practitioners can work together to take headaches away from the nursing homes, because the nursing homes and assisted living facilities are dying with this pandemic of pills we have in this country.

[Polypharmacy management is] not a quality measure, but it leads into many quality measures. Hospitalization prevention, falls, discharge to home, rehab. How can you do good rehab when you’re on an antipsychotic? These medication issues play into everything. It bleeds into the cost of care. It plays into staffing times. It impacts all kinds of quality measures.

Our nurse practitioners now working with consultant pharmacists on a regular basis is just one example. Physicians should never be the leaders, they should be facilitators — everybody on the team should be a leader.

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