This article is sponsored by Real Time Medical Systems. In this Voices interview, Skilled Nursing News sits down with Dr. Steven Stein, Chief Medical Officer at Real Time, to learn how value-based care is manifesting in the skilled nursing industry. He discusses the key role SNFs play in the advancement of value-based care and breaks down the top ways SNFs can become integral providers for their health partners.
Skilled Nursing News: What career experiences do you most draw from in your role today as Chief Medical Officer at Real Time Medical Systems?
Dr. Steve Stein: I spent a lot of years as a practicing geriatrician, and I’ve taken care of a lot of older people in my life. I am very familiar with the most common medical issues that lead to rehospitalizations and how many of these transfers are preventable if you catch them early. At Real Time, despite the fact that I’m not interacting with the actual resident, I know that if we can support nursing facility staff and physicians with important and timely information, we can make a difference in the lives of the residents by enabling their clinicians to make better informed decisions.
As Chief Medical Officer for the central region at UnitedHealthcare, I recognized the importance of data analytics in identifying the highest risk patients and developing an actionable strategy for our members and our plans. That position helped me understand that it’s important to be cost-effective and that you can do a great job while being highly efficient. I’m glad that Real Time has been able to help support facilities, HMOs, ACOs and health systems with the kind of information that supports higher quality care and lower non-value-added costs for skilled nursing facility residents.
Also, during my time at Trinity Health, where I served as Chief Medical Officer for Continuing Care, I oversaw Bundled Payment Care Improvement Model 3, where nursing homes took on risk for the 90 days post-hospitalization. By making sure that our case managers, nursing facility staff and physicians had the information they needed to make timely, well-informed decisions, we had a lot of success.
All those experiences have led me to support Real Time and its mission of enabling clinicians to deliver better care by leveraging our live patient data.
What major trends around value-based in skilled nursing do you anticipate seeing in 2022?
Dr. Stein: COVID-19 has placed a spotlight on infection control practices in SNFs that will continue beyond this pandemic. A new CMS measure on SNF Healthcare-Associated Infections Requiring Hospitalization will continue to be a closely watched outcome.
I also think that HMOs, DCEs, ACOs and health systems will continue to look at two major metrics: readmission rates and length of stay. Skilled nursing facilities, though, will not only be required to do a great job while patients are in the building but also set the patient up for success in the community. I would not be surprised if CMS begins to measure a 30-day post SNF readmission rate to support that aim.
Why should value-based care be at the forefront for nursing facilities?
Dr. Stein: Nursing facility referral sources — ACOs, hospitals and health plans — expect their network partners to align with their value-based payment strategies and deliver on clinical outcomes across episodes of care and across settings.
Real Time can help facilities reduce inpatient costs and improve patient outcomes by leveraging live post-acute analytics to risk stratify patients and prioritize care based on acuity and prognosis. By delivering exceptional care based on timely patient data, you’re able to reduce infections which could have led to a higher acuity level requiring hospitalization. Such information also leads to fewer survey citations as the facility is catching issues before they become acute.
Nursing facilities that can leverage actionable data to improve these types of outcomes are practicing value-based care.
What is the most important role that SNFs play in value-based care?
Dr. Stein: There will always be older people who don’t have the social supports necessary to go home after a hospitalization. Whether it’s due to a decline in functional status or an inability to manage an IV for antibiotics, there will always be a need for a skilled nursing facility. But a crucial part of value-based care is ensuring that there isn’t a high-cost hospitalization during the SNF stay or soon after.
There’s a lot of measurement around length of stay because it is not like a DRG (diagnosis-related group) where you have a fixed payment and there is a lot of variability across SNFs. A nursing facility has to think about the fact that if they can deliver care efficiently and effectively, while the days in the SNF will be shorter, the number of referrals will be greater. That’s the trade-off.
What are the top initiatives that a SNF can take to become an integral provider to its health partners?
Dr. Stein: Leveraging actionable information so that they can act nimbly at moments of high risk is crucial. Real Time provides live post-acute analytics to support informed decisions, not only for skilled nursing facilities, but for HMOs and ACOs too. With SNF staffing shortages occurring nationwide, nurses don’t have the time to seek out information documented by other team members. There is a need for some immediate analysis of meaningful information to support morning rounds, infection prevention and readmission strategies.
Sharing data with hospitals is another key piece of becoming a successful and integral provider, because getting information back to the health care partner so SNFs can relay the quality of care they’re providing is a top priority. Health care partners want to know that you learned from them and created an approach to prevent the next adverse event. Being able to share your results from last month or last quarter reduces the risk that a SNF will be removed from the preferred network based on year old data.
What risk-sharing strategies can nursing facilities implement with partners?
Dr. Stein: If the facilities have confidence in their ability to prevent readmissions, then one could create a risk-sharing contract that allows the skilled nursing facility to benefit from lowered readmission rates. Also, if their data is in real time, they’ll be able to monitor how they’re doing day to day and month to month and adapt as needed.
The same goes for reducing length of stay. If you have the right information and know when it’s safe for a patient to go home, you can reduce your length of stay by discharging residents truly safe to transition while justifying a longer stay for those residents who need more time in the facility.
How is Real Time helping nursing facilities better address those risk-sharing opportunities?
Dr. Stein: We are addressing those opportunities in a few ways. We have an alert system that identifies patients who might require hospitalization if action is not taken in a timely manner. Some of the readmission risk tools out there tell you somebody is at risk, but very few can alert you in real-time when something is brewing. That’s major.
Real Time also has reports that guide nurses and physicians on which residents require attention on rounds, due to clinical alerts that were triggered in the previous 24 hours, as well as information that enables SNFs to look at the diagnoses that they excel in their care and others where there are opportunities for improvement.
Real Time allows a SNF to quickly identify the readmission risk level of a resident as well as their functional status. These tools, when combined, become a strong screening process to determine who may be safe to go home or transition to custodial care.
We offer all of that as well as a strong infection control dashboard, so that as things get tight in regard to how the government is scrutinizing nursing homes, facilities can share trends about their infections. Real Time has been able to help SNFs identify new diagnoses of COVID through its data surveillance technology that mines all of the clinical team’s documentation.
Entering this year, no one knew fully what to expect in the skilled nursing industry, what has been the biggest surprise to you, and what impact do you believe that surprise will have for the remainder of the year and into 2022?
Dr. Stein: I was surprised by the impact COVID has had on staffing. Real Time uses post-acute analytics to enable staff to focus their time on the residents who most need their attention. There are just not enough resources to be inefficient with the time of nurses, aides and therapists.
The staffing shortage speaks to the fact there is so much focus on COVID that other conditions sometimes are not getting the attention they deserve. Having alert systems in place, having real-time data to look at trends, and having reports that let you know how things are going down become even more important.
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