June 24, 2020
By: Steven Goldschmidt, Vice President, Post-Acute Care, Collective Medical
Skilled nursing facilities (SNFs) are experiencing almost unthinkable levels of stress in 2020, as their efforts to mitigate infection—in particular, the spread of COVID-19—are under a microscope.
SNFs saw more than 107,000 confirmed cases of COVID-19 through June 18, according to data released by the Centers for Medicare & Medicaid Services (CMS), which required federally certified nursing facilities to report this data beginning May 17. Among these patients, nearly 30,000 have died, representing more than a quarter of the known coronavirus deaths in the United States.
But as tragic as these statistics are, they don’t tell the whole story. Most states are reporting higher numbers of COVID-19 cases and deaths than the CMS report indicates. That’s because federal guidelines require states to report data from nursing facilities, not all long-term care facilities. In at least 18 states, COVID-19 deaths in SNFs account for at least half of coronavirus deaths in the state, according to the Kaiser Family Foundation. Meanwhile, an additional 71,000 SNF-based COVID-19 cases are suspected.
As a result, CMS has turned up the heat on SNF infection control processes, increasing penalties for noncompliance with infection control standards. States that have not completed all of their focused infection control nursing home surveys by July 31, 2020, could potentially see their CARES Act allocation for FY2021 reduced by up to 15%.
These new mandates are tough, especially for nursing homes in the hardest-hit communities. And while the focus is on safety measures, many have raised concerns that there is no correlation between a SNF’s federal quality rating and the probability of COVID-19 infection among its patients. As R. Tamara Konetzka, a professor at UChicago’s Department of Public Health Sciences, noted during a hearing held by the Senate Special Committee on Aging, “Nursing homes with traditionally underserved, non-white populations are bearing the worst outcomes.”
With higher fines for noncompliance at stake, how can SNFs more effectively prevent spread of COVID-19? Improved communication, care coordination and collaboration with home health agencies (HHAs) and other care partners are key elements of a safety-focused response.
The Bigger Picture
With nursing homes emerging as a hotspot for COVID-19, the need to double down on infection control puts added pressure on health care workers serving the most vulnerable populations. Patients in SNFs typically have complex conditions and must be carefully managed. It’s not uncommon for 80-year-olds recovering from hip-replacement surgery to also have diabetes, hypertension or dementia – all associated with a higher risk of rehospitalization.
The pressure doesn’t end when states lift restrictions on care. For example, many patients continue to postpone elective—but critical—surgeries even after states give the go-ahead for a return to service. These delays in care may increase patients’ risk of hospital readmission—and of contracting COVID-19 in a hospital, particularly in hard-hit urban areas like New York, which still faces shortages of personal protective equipment such as N95 masks.
The reality is that SNFs have little control over the spread of COVID-19 within their respective communities. Most facilities have seen the current guidelines and are doing their best to close gaps in infection control practices.
However, SNFs hold the power to improve the flow of information between providers as well as transitions in care, such as transfers of patients between nursing homes and HHAs. In doing so, they become better positioned to prevent rehospitalizations and control infections, including coronavirus outbreaks.
While CMS has long pushed for greater interoperability between care partners, many SNFs aren’t taking advantage of opportunities to improve care transfers. It’s not atypical for SNFs or HHAs to spend hours calling hospitals, trying to fill in the gaps in a patient’s recent health history. This is precious time that could mean the difference between providing essential follow-up care and sending a patient to a hospital emergency department (ED) for a flare-up that could easily have been prevented onsite. The difference in risk between these scenarios increases the potential for COVID-19 infection and—when the patient returns to the SNF for care—leaves SNFs vulnerable to an outbreak.
Examples from the Frontlines
Today, leading SNFs rely on technology solutions that close gaps in care information during transfers, ensuring availability of critical data at the point of care.
ADT-based care collaboration platforms, for example, alert SNFs, HHAs and other care partners when a patient is admitted, discharged, or transferred from one setting to another. These real-time notifications enable faster and more appropriate follow-up care, lowering the risk of hospital readmission and hospital-acquired infections. For example, by alerting health care providers when patients have preexisting and/or frequent recurring infections, clinicians can implement preventive measures quickly, improving outcomes.
At Milwaukie, Ore.-based Marquis Companies, use of a notification system that picks up alerts from multiple area hospitals helped SNF staff to reduce hospital readmissions by 60% in less than 6 months. When former Marquis residents seek treatment at a health care setting in the network, SNF providers receive instant, real-time alerts. This enables medical staff make time-sensitive decisions – such as whether care can be more effectively delivered by Marquis – so the patient can avoid hospital readmission.
Another organization, Housecall Providers, also saw impressive results when it leveraged its ADT-based network to reduce the administrative workload of intake staff, who managed more than 2,300 patients. The organization no longer spends dozens of hours each week calling hospitals to try to locate patients. Instead, real-time data provides highly accurate information on patients’ whereabouts. Within the first year of implementing this network, Housecall Providers met all six key metrics in the Medicare Independence at Home program—including patient follow-up after hospital discharge, medication collaboration, and managing patient preferences for care. Housecall’s efforts saved Medicare $1.8 million in care costs and was about to receive 80 percent of those savings back. The practice has continually met these metrics, leading to $500k to $1.2 million in reimbursements every year.
Solutions such as these empower post-acute care facilities to make informed care decisions for high-risk patients – and prevent citations for noncompliance with federal infection control protocols.
Steven Goldschmidt is Vice President, Post-Acute Care for Collective Medical. A longtime post-acute software specialist, Steven leads Collective Medical’s post-acute strategy and business development initiatives.