Staffing shortages and increased acuity of patients are playing a big role in referral placement, along with preferences and prerequisites of referral sources. This is causing nursing homes and hospitals in high-demand areas to get creative with in-house offerings and hospital partnerships, as they are still experiencing bottlenecks in the referral process.
At the same time, operators are figuring out how to make the transition in care more seamless for patients, said Dr. Taimur Mirza, chief medical officer for ArchCare, while also moving certain subsets of patients from the hospital to the nursing home. This is especially true for those that are Medicare Advantage beneficiaries.
Moreover, managed care organizations (MAOs) all have different parameters for credentialing and contracting with nursing home operators, which creates a challenge with referrals, according to Benton Collins, regional vice president of operations, PACS Group (NYSE: PACS).
“You might have one hospital and 12 skilled nursing facilities, but based upon the parameters that a managed care organization might have, they might only be contracting with five or six of those skilled nursing facilities, and that really narrows the subset of SNFs that patients are able to be discharged to,” said Collins..
Collins and Mirza weighed in on the state of referrals in the sector and discussed how to build a good reputation among referral sources during Skilled Nursing News’ webinar on Wednesday.
ArchCare is a continuing care retirement community (CCRC) of the Archdiocese of New York and operates nursing homes in six locations in the state., while PACS is one of the largest skilled nursing providers in the country, with a portfolio numbering about 270 nursing homes.
Building referral source relationships
Having positive relationships with MAOs can help with referrals, Collins said, because this leads to a greater chance of a facility becoming part of a preferred network with the MAO. This goes for other referral sources too, like community-based individual markets, home health players and assisted living.
“There’s really no substitute, in my opinion, for positive word of mouth,” said Collins. “When our patients discharge, are they going home and feeling happy, and are they communicating that with their families, with neighbors?”
Physician relationships, he said, are another major factor when it comes to referrals. Patients lean on the opinion of their physician when deciding on a nursing home – their doctor knows the area, and health care players in the community.
Positive relationships with physicians means more recommendations, but the nursing home needs to ensure they are able to properly take care of that patient from a staffing perspective. Staffing is a main driver of bed availability, Collins said, with some facilities simply not having the staff to accommodate the needs of prospective patients.
Mirza said referrals at their nursing homes in Manhattan and the Bronx follow a seasonal pattern, with census during the winter months being full, and nearby hospitals having a full census as well. And in the summer, the census is lower.
“Post-pandemic, I do think that we’ve seen the [referral] numbers in general are larger. We’re getting a lot more referrals, and we’re having to deny a lot just based on bed availability,” said Mirza. “The patients have become a lot more acute. Trends have been changing post-pandemic, and we hope we can still have a smooth transition for our patients from the hospital to the post-acute side and ultimately home.”
ArchCare has its own home health care agency and hospital under the same company umbrella, making it somewhat easier to coordinate referrals and recommendations.
“If we can refer within the system, we’ve been able to accept patients from Calvary Hospital who are doing better into our sub-acute rehab, and vice versa,” said Mirza. ArchCare’s hospital also provides palliative and hospice care, spanning a wide swath of the care continuum.
Ultimately, Mirza hopes nursing homes will be like extensions of the hospitals, and patients see themselves as just moving to another ward where they’ll be taken care of. It’s all part of the evolution that nursing homes are currently undergoing to take on more complex cases, he said.
“We’re going to have to do more in-house,” said Mirza. “We’re going to have to have better labs, radiology, point of care testing, in-house consultants, dialysis, vent units, and this will eventually just be to take the burden off of the hospitals, which will become more like large ICUs.”
Partnerships for smooth care transitions
ArchCare is already moving toward this type of model, cultivating more specialized post-acute care. The nonprofit has piloted a couple of programs, first with the Hospital for Special Surgery (HSS). ArchCare’s Mary Manning Walsh Nursing Home and Rehabilitation Center opened up a floor for their hips, knee and spine surgery patients who needed a couple of days recovery in post-acute care.
“In return, they provided us with a nurse manager who is an HSS employee who also looks over the patients and works at Mary Manning, as well as being a lead physical therapist,” said Mirza. “There’s definitely a lot of continuity of care there, and we saw really positive results. Patient satisfaction in that unit is 95%.”
The other partnership is with Memorial Sloan Kettering Cancer Center (MSK) and Mary Manning, which added a floor for their patients who need some acute rehabilitation but also have appointments for radiation, chemotherapy and follow-up care.
“Since these patients are a lot sicker, every week we have an MSK hospitalist who comes in, rounds with our doctor five days a week, Monday through Friday, and helps coordinate all those appointments, and really just provides reassurance to those more complex patients,” said Mirza. “I think this is where we’re going to start heading … for ArchCare, at least.”
Companies featured in this article:
ArchCare, Centers for Medicare & Medicaid Services, PACS Group