For nursing home providers, lean times demand extracting financial gains by not only using new service lines but also value-based care options more effectively, while thinking outside the box to apply multiple uses for technology currently being deployed.

Nicole Kaufman, chief transformation officer at Genesis HealthCare, stressed the importance of clinical integration and deploying third-party case management to tackle a high volume of complex referrals – a move that has been quite useful in maximizing reimbursement for the organization.

At Genesis, the focus on clinical integration uses facility assessments to guide business plans and align with hospital systems for better patient care and partnerships. Kaufman said the goal is to grow revenue by targeting specific patient types, improving care quality, and partnering with providers, all while ensuring patients can discharge safely without complications.

“As we think about revenue streams, we’re just leaning in to going after much more specificity, and honestly, where we see margin [growth is] with certain patient types based on our reimbursement, based on our strength of care, delivery, the services that we offer, so that we can capture the best rate,” Kaufman told Skilled Nursing News.

Pennsylvania-based Genesis is one of the largest post-acute care providers in the United States, with a portfolio of nearly 180 skilled nursing centers and senior living communities across 17 states.

A panel at SNN’s RETHINK conference featuring Kaufman and Heritage Operation’s COO Steve Hart, discussed how skilled nursing providers are pivoting for the future using not only third-party case management and clinical integration but technology in very unique ways. 

Perhaps the most novel suggestion is how nursing homes can engage in Bitcoin mining. While health care organizations might not be directly involved in cryptocurrency mining, exploring blockchain technology – a type of digital ledger – for secure and transparent data management is said to be useful for the sector. That said, the process is difficult, needing costly equipment, which uses a lot of energy – and releases abundant heat. 

This heat doesn’t have to go to waste, however, leading to gains on reducing a facility’s heating bill while the Bitcoin mining is taking place, Hart said.

Illinois-based Heritage owns and manages over 40 senior care facilities throughout the state, including skilled nursing. Last year Heritage went through a big reset by selling 22 of its 44 SNFs.

Managing high referral volume, standardizing care

To alleviate issues from a high volume of referrals – which can make it difficult for admissions and clinical teams to manage them given the involvement of multiple ACOs, bundled payments, and third-party providers – Genesis partnered with an external case management group to help streamline and inform care planning.

While Genesis still does some case management in-house, according to Kaufman, her organization has also relied on outside experts to guide clinicians and medical directors in understanding the specifics of each patient agreement, ensuring that teams focus on delivering quality care without being overwhelmed by administrative complexity.

In New Mexico, for example, the organization receives about 1,000 referrals a month from various preferred provider networks, including ACOs and those driven by physicians or hospitals. The staggering number of referrals has made it challenging for Genesis’ admissions, social services, and clinical teams to effectively manage the influx, Kaufman said.

“And so we were losing some of the nuance in [dealing with say] eight patients today, with five different ACOs, three different bundles, and two preferred providers. It’s a sophistication around case management that we really had to go after,” she said of the dilemma.

It led to Genesis partnering with a third-party case management group.

“So although we still have some case management within our organization, we’re relying on experts to really help drive what we need to know, what our clinicians need to care plan for, and what our medical directors need to understand about this ACO or that bundle, so that we can use the expertise closest to the bedside,” she said.

And as for Heritage, aligning with ACOs has been helpful in standardizing care.

“[ACOs] are where the next 10 years we’re going to see everything head,” Hart said. “It’s tremendously important if you’re going to risk reimbursement for quality of care, that you should reduce variability,” he said. “If the incentives are going to align with quality, you should position yourself to have durability in your clinical processes.”

Creative tech uses and Bitcoin mining

A greater deployment of technology is important too for standardizing clinical care.

Technology has improved fine-tuning dietary needs at Heritage, and reducing adverse incidents, such as resident choking episodes, by allowing a close tracking of patient meals without miscommunication of needs, Hart explained.

“We saw an increased number of choking episodes when individuals were eating in their rooms. And what we found as a root cause was that the nurse who received that diet order maybe didn’t communicate that to the kitchen, and [the resident] received their own diet type,” he said. “By using technology, we helped to eliminate the need for that communication and have created a more robust system.”

And sometimes, extreme times demand extreme strategies. As nursing homes grapple with making operational changes to address the lean era for funding, Hart is advocating using creative solutions such as using heat produced in Bitcoin mining, an energy intensive process.

At Heritage, Hart said that the company expects to draw out energy benefits from placing Bitcoin mining equipment next to facility boilers.

“We can use the excess heat from data processing to mine Bitcoin without additional energy costs,” he said.

This repurposes waste heat into a potential revenue stream, depending on boiler usage and future economics.

“There are systems today where you could essentially put the data mining capability right next to your boiler and for no cost, essentially you spend the exact same amount on energy,” said Hart. “[That’s] an interesting way to produce something new and basically take a waste product and turn it into a revenue source.”