‘Inflection Point’: Funding Woes Limiting Tech Usage Needed To Drive New Care Models, Payment Frameworks at Nursing Homes

The skilled industry industry may be at an ‘inflection point’ when it comes to adopting novel technologies, new payment frameworks and evolving care models amid challenges facing the sector.

But a hopeful picture is emerging for operators seeking to improve clinical care, and some of it depends on how they innovate and fund the changes.

Some nursing home providers are shifting to decentralization care models that allow for more flexibility in catering to regional needs and payor mix as they expand their footprint. And others see adding value-based care initiatives as well as on-site clinical services ranging from memory care to dialysis as being valuable. All agree, however, that the newer care models will come to rely upon deployment of new technologies.


At Skilled Nursing News’ recent CLINICAL conference, Ariana Moreau, director of Clinical Services at A.G. Rhodes, Rhonda Dempsey, chief nursing officer at Trilogy Health Services, and Sally Cantwell, senior VP of Organizational Development at PACS, said that the early success of care models currently at play is showing that SNFs can adapt to market demands and drive positive outcomes for residents while ensuring financial viability, especially by fostering strong partnerships, embracing technology, and prioritizing quality care.

Remote patient monitoring and predictive analytics are beginning to play an essential role in identifying potential risks and changes in patient conditions, Moreau said.

“We historically have been the last industry to kind of adopt new technologies,” she said. “I think increasing reimbursement is going to be key there, because we have to find ways to pay for it.”


Moreau added that technology can provide early warnings and streamline the focus of clinicians, ultimately improving patient care.

“You’ll know potential fall risk or elopement risk or acute sudden changes in condition when they’re not at the bedside [through predictive analytics],” she said. “[Predictive analytics] can give you warnings … these are the people you might want to look at, so that you can narrow your focus.”

Moreau said she is optimistic about the adoption of new technologies in the healthcare industry, stressing the need for increased reimbursement and regulatory reform to support this shift.

“We’ve got to figure out a way to come to the table and come to a happy medium, because of this paradigm shift in our industry,” she said. “We are at an inflection point right now. I do believe that over the next five to 10 years [new technology is] going to be a big component of this industry, in the success of this industry.”

Maintaining Quality Amid Growth

Cantwell said that with PACS expanding in multiple regional markets, a decentralized model is key to their success.

“All of our administrators and DONs, friends and clinical staff on site make their decisions, but then we have robust regional clinical teams that consult and mentor,” she said. “We don’t compromise on our clinical processes. So those are our standardized processes, our clinical processes.”

She also said it is important to build managed care partnerships and understand each facility’s skilled mix.

With your managed care, [it’s important] you understand what your skilled mix is, that you understand the type of patients you’re bringing in and then can appropriately align care with the billing model,” she said. “The more you understand that, the more intentional you can be with those models.”

She also stressed the need to be proactive and intentional rather than reactive to avoid financial challenges.

For us, that’s paramount as we begin being proactive and intentional about not being reactive because all of a sudden, you’re going under because you haven’t been able to control your finances and that billing mix, because the goal is patient-centered care,” she said.

Cantwell said she is hopeful for improvements in managed care contracts, reimbursement rates, and the desire of nurses to work in skilled nursing and post-acute care facilities.

“Talent of high quality [nurses] really changes the landscape inside our facility,” she said. “So, having well-trained, highly-educated [staff], and attractive places [help] to recruit high quality staff.”

Adapting to market needs

Dempsey said Trilogy’s partnership with other providers in Indiana, leading to the establishment of an I-SNP (Institutional Special Needs Plan), is scheduled to go live in 2025.

The I-SNP, among other efforts, is a part of Trilogy’s strategy to adapt to market needs. Another initiative included establishing dialysis units within facilities to address transportation challenges faced by patients.

She said that by establishing dialysis units within their facilities, Trilogy aims to alleviate the burden of transport for patients, ensuring they can access necessary medical care conveniently. The units are owned and operated by Trilogy.

“We get a lot of referrals for dialysis, and people don’t want to take them because transport is an issue,” she said. “It’s been effective in the right markets. It’s beneficial to our residents because they don’t have to worry about transport. They just roll to the unit, get dialyzed and go back.”

She said that by working with hospitals, the model drives business but also fosters collaboration between healthcare entities.

“It also helps with short term admissions, where we can meet their needs and get them back out to the community,” she said.

Moreau said A.G. Rhodes’ responded to Atlanta’s traffic issues by partnering with a dialysis provider in two of their facilities.

“A lot of the hospitals were really struggling to get those dialysis patients placed, because of transport costs and the burden on the patient like sitting in traffic in Atlanta,” she said. “It might only be 10 miles, but that could take over an hour, two hours, depending on the traffic.”

Moreau added that since memory care is a big need in the industry, A.G. Rhodes added specialized units for patients with memory care needs.

“There’s not a lot of specialized places for that,” she said. “So, we expanded one of our homes and added a new unit that is specifically designed for those living with dementia and memory care.”

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