VOICES: Scott Rifkin, MD, Founder and Executive Chairman, Real Time Medical Systems
This article is sponsored by Real Time Medical Systems (Real Time). In this Voices interview, Skilled Nursing News sits down with Scott Rifkin, MD, Real Time’s Founder and Executive Chairman, to talk about the impact of value-based care in the skilled nursing industry. Scott provides his insight into the future of value-based care with post-acute and long-term care populations, and offers his perspective on how post-acute providers can prepare for meeting CMS’ Accountable Care Organization relationship goals while adapting to value-based delivery models.
Skilled Nursing News: What life and career experiences do you most draw from in your role today?
Scott Rifkin: I’ve seen all sides of the long-term care business and I’ve had the opportunity to experience every aspect of post-acute care during my time in the industry. 30 years ago, I started my career as the medical director of a nursing home where I did all of the turnaround work for the state of Maryland. After that, I bought a nursing facility and grew the organization to 4,000 beds across 21 facilities, which allowed us to create both Real Time and our value-based care company, Provider Partners, as spinoffs of the core business. From the patient experience to the highest level, I draw from all of my firsthand experiences in my role today.
Value-based care is here. How does this shift in care delivery differ from previous models?
Rifkin: The beginnings of value-based care are definitely here, and CMS intends to have every patient in a nursing home under a value-based contract by the end of this decade.
A lot of operators either aren’t ready, or they don’t want to be in value-based care. But whether they like it or not, it’s happening. If providers can keep people healthy, it reduces the cost of care and lowers the strain on hospitals. In turn, CMS provides opportunities to let doctors, insurance entities, and other health groups share in those savings, as long as the patients see better outcomes.
For the nursing home industry, this is a huge positive. The old fee-for-service system we lived under didn’t encourage good outcomes or quality care. It encouraged volume and a lot of procedural tasks that didn’t need to be done — that’s a big reason why the nursing home industry has a terrible reputation amongst the public. If we want to be on the high road and provide better care while getting more dollars back from the federal government, bluntly, we have to change the reputation of the long-term care industry.
That means centering payment and incentives on better patient outcomes. Folks will respond to that, and we’ve seen it. In the ISNPs, hospital readmissions dropped as much as 50-60%. Patients see nurse practitioners frequently when they’re sick, and in the old fee-for-service system, they might be seen once or twice a month by a doctor. The whole concept of value-based care is good for the industry, good for the reputation of the industry, and most importantly, it’s good for the patient.
How does value-based care impact post-acute care specifically, and what does the future of value-based care look like in the skilled nursing industry?
Rifkin: You have to break them into two groups: The short-stay patients and the long-term care patients. Post-acute value-based care is coming out of the community programs, which admit a certain number of patients to nursing homes.
Under fee-for-service, the system has been largely abused with long-term stays that are much longer than necessary. Under value-based care, a lot of that will be reduced. Operators will realize that if they do a good job keeping people healthy, then insurers, Accountable Care Organizations (ACOs) and Medicare Advantage plans, commercial insurers, are going to steer more patients in their direction. The insurers want to send patients where they will get the best care and where the total cost of care is controlled.
If I’m an operator and I want to succeed in the long run, value-based care is the best option for SNFs and patients alike. To achieve more admissions and higher fees associated with skilled nursing, providers have to demonstrate better outcomes and better length of stay. It’s a trade-off of outcomes for volume.
With CMS’ goal of having 100% of Medicare beneficiaries in an accountable care relationship by 2030, what challenges do post-acute providers face in meeting that goal?
Rifkin: Operators need to change the way they think, because right now, most have been living in a fee-for-service world and they want to optimize length of stay. Additionally, they are not incentivized to have extra staff because they’re getting paid on volume, not on care outcomes.
To survive and thrive in a value-based world, providers have to figure out how to use their resources to keep patients healthy and out of the hospital. Then, they have to judge what to spend money on and consider what programs will help cover necessary costs.
Data mining, for example, can help reduce hospital readmissions dramatically. When operators take this to heart and see the return on investment in data and caregivers, they’re going to keep investing. It’s human nature. The fact that CMS is pushing them to do it, will help operators that were hesitant to take the critical next steps.
The first step is learning about the programs that exist, like the ISNPs and the ACO REACH programs. Step two is figuring out who their partners are going to be. And step three is educating the care team on what is most important to the facility and its patients. There are very forward-looking organizations all over the country that are starting to dip their toes in the water of value-based care and learning how to make it work. In a couple of years, it’s going to be the dominant care delivery model.
How can post-acute providers prepare for meeting CMS goal while adapting to value-based care delivery models?
Rifkin: Again, it’s all about educating your team and figuring out what resources make the most sense relative to your goals.
Real Time’s Interventional Analytics solution can help providers optimize their resources by identifying patient anomalies and helping them get in front of health issues that can lead to higher costs and rehospitalizations. If someone hasn’t had a bowel movement in three days, we can treat that for 50 cents worth of stool softener, instead of the patient getting septic two days later and going back to the hospital. We can look at patients who are gaining weight with a history of heart failure and recommend a little bit of Lasix to prevent that admission.
However, a software platform is worthless if the organization behind it doesn’t have a direction. Providers utilizing tools like this are seeing 30% or higher reductions in hospitalizations. These organizations are leading their team to prioritize what’s important.
With technology constantly evolving, what role does it play in helping care providers succeed in value-based care?
Rifkin: There is no way that a team of nurses and nursing aides in a facility can know everything that’s going on with every patient — even if they have the information.
Sometimes the information is there to prevent medical issues, but it’s very hard to get revolving shifts of staff up to speed on everything that’s going on in the patient’s medical record because they’re so busy putting out fires.
The basics of data mining that we’ve used in other businesses for a decade or more are just now becoming a major factor in nursing homes. Providers can use the same ability to find those interventional moments, push them to the right staff member, and tie it to protocols. When the staff follows, admissions go down dramatically.
Some studies indicate that 50-70% of admissions from nursing homes to hospitals are preventable — organizations just have to use the available tools. Every single facility in the country should be doing a basic data mining program for regulatory performance, quality of care, and success in value-based care. Better patient outcomes are driven by data-focused technology and more robust staffing, and those will be key components in value-based care.
Finish this sentence: “In the skilled nursing industry, 2024 will be defined by…”
Rifkin: Operators’ use of tools and resources as they navigate the increasing presence of value-based care.
You may view this article on the Skilled Nursing News website, here.
