VOICES: Phyllis Wojtusik, EVP Health System Solutions, 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 Phyllis Wojtusik, RN, Real Time’s EVP of Health System Solutions, to discuss the shifting skilled nursing payment landscape and how partnering with multiple Accountable Care Organizations (ACOs) can help providers navigate it. Phyllis outlines the steps SNFs can take to identify the best ACO partner for their organization. She also provides key strategies that SNFs can leverage to collaborate with ACOs and drive quality care and improved patient outcomes moving forward.

Skilled Nursing News: What life and career experiences do you most draw from in your role today?

Phyllis Wojtusik: I’ve always known that I wanted to be a nurse. From the age of four or five, I wanted to be like my mom, who was a nurse. It was mostly because I loved the hat she wore to work and was enamored by it—I wanted one of my own.

Following that early inspiration, I started my nursing career in critical care, then became a charge nurse, and later a nurse manager of a specific unit. I went from impacting one or two people to affecting 60 or so on a daily basis. After that, I became a care manager, which allowed me to reach different populations. This experience fueled my passion for population health, which has been the focus of the majority of my work over the past 15 to 20 years.

In particular, I worked in geriatrics and became very attached to those patients. While they are vulnerable, I find them to be one of the most interesting populations. They have lived through experiences that many others haven’t, and often possess a wealth of wisdom they are eager to share.

That passion for population health, and particularly geriatrics, really drove me to my current role.

I’ve learned that it’s not about fitting what we think should happen into their lives; it’s about adding value to their lives through health care, which means different things to different people.

Through that lens, can you briefly explain CMS’s goal of having all Medicare patients in a value-based care program by 2030?

Wojtusik: CMS understands that, first and foremost, value-based care saves money—something they’ve proven repeatedly through ACOs and other programs. It also improves patient outcomes, and what’s not to love about that? You save money while enhancing patient care—two goals everyone is working toward.

Value over volume is the goal, and by empowering us to manage value-based care programs, they’re putting us in the driver’s seat to drive change. Rather than mandating our approach to care, they’re giving us, the experts, the freedom to be creative in achieving savings and improving patient outcomes.

I think that’s very powerful for all sectors of the health care industry because driving value empowers us to improve care and reduce overall costs.

Taking that a step further, with the continued transition to value-based care, why is it integral for SNFs to partner with multiple ACOs?

Wojtusik: The first answer to that is volume. Hospitals used to be the primary driver of volume to SNFs; now, value-based care entities are taking on that role.

If you want to remain relevant in that feeder chain, you really need to work with those value-based care entities. Would you contract with just one insurer if you were a SNF? It’s crucial to understand what’s happening in your region and to contract with multiple ACOs, as each one will act as its own feeder.

If a SNF is already working with an ACO, do they still need to partner with other ACOs? How do you know which ACOs to partner with?

Wojtusik: In the relationship between an ACO and a SNF, it’s important to understand that ACOs are really focused on driving quality. Their livelihood depends on meeting specific quality metrics and earning bonuses for doing so. This is one way the post-acute arena can learn from ACOs. ACOs establish clear targets—such as length of stay, readmissions, and clinical standards—and standardize care around those metrics.

ACOs are primary-care-physician-attributed. Whether those primary care doctors are employed by an acute care system like a hospital or operate as an independent group, who better to work with than the people who set the standards?

When you become recognized in your area for outstanding quality and strong patient outcomes, you become the provider of choice—not only for value-based care organizations, but for patients, hospitals, and Medicare Advantage plans.

What are the benefits for SNFs in partnering with multiple ACOs?

Wojtusik: Again, it all comes down to volume. When you’re recognized as a good partner, value-based care organizations will begin to shift volume your way.

For example, a Continuing Care Retirement Community (CCRC) offered assisted living, SNF beds, and independent living, but their independent living units didn’t have enough patients to support the SNF or assisted living. They were a good provider and worked hard to meet the ACO’s outcomes, yet the ACO faced a challenge. They had patients living alone, needing knee or hip replacements, but struggled to arrange transportation for prehabilitation appointments.

If you’re undergoing a joint replacement, most physicians recommend prehab to strengthen the muscles around that joint and ensure you’re in good physical shape. For this CCRC, the ACO developed a program to prehab patients for two or three days before their surgery.

The patients had the option to participate. If they didn’t have anyone in their area to help them get to the prehab appointments, they could choose to go to assisted living for a reasonable set fee, which wasn’t excessive, but it occupied an assisted living bed. After surgery, the patient may or may not require skilled care post-discharge from the hospital.

Those patients went back to either the SNF, if they required skilled care, or to assisted living, at a set fee, for three or four days until they were able to return home. This was a significant volume driver for this particular CCRC.

What are some of the strategies that SNFs can utilize to work together and collaborate on patient outcomes with ACOs? What should SNFs be looking for in these contacts from the ACOs? What’s in it for them?

Wojtusik: In the end, it’s all about volume. While ACOs are a primary focus, programs like I-SNPs also offer SNFs incentives for managing the patient in place and minimizing hospital readmissions, creating additional revenue streams.

Using the quality metrics you’re receiving from the ACO to earn a percentage of shared savings or to partner with the I-SNP, while meeting quality, admission, and readmission goals, can significantly drive revenue. As you continue working with value-based care organizations, they should be open to discussing shared savings with you. In one way or another, they rely on you to help secure some of those shared savings.

Nationally, a single readmission is valued at around $16,000 to $17,000. If you start saving an ACO two or three readmissions per month, it adds up to an impressive amount of money.

If you perform well, you can go back to your ACO and say, “Hey, we’ve saved a lot of money. How can we work together to share in some of those savings?” From a SNF perspective, it’s a win-win. You achieve better quality outcomes and the recognition that comes with them, while also tapping into additional revenue streams. Getting paid more for the same work that you’re already doing—that’s a great strategy.

Finish this sentence: “In the skilled nursing industry, 2025 will be defined by…”

Wojtusik: An additional push toward value-based care programming. The facilities that fully embrace this shift will continue to see increased volume and success.

You may view this article on the Skilled Nursing News website, here.