Lawyers Peer Into Elder Care's Crystal Ball - Part One

423145_10150655438267770_313997954_nTraveling to Las Vegas, in search of a few days respite from this tiresome winter weather, recently brought me to the 2014 AHLA, Long Term Care and the Law Conference. The theme of this year's conference should have been, "tremendous change is coming and some have a good idea what it will look like, but how quickly we get there and what catalysts will trigger the change, remains uncertain." In other words, there is a lot of “hurry up, and wait” going on in the post-acute care (PAC) world. Skilled nursing facilities (SNFs) continue to search for market share, where margins are sufficient to drive ROI, while hospitals and insurers seek to drive down cost (i.e. risk) on to the backs of the PAC providers (and to a certain extent to the patients). Scattered among the sessions on compliance programs, telemedicine and legislative updates, where several programs on managed care organizations, affordable care organizations and discussions on the PAC environment. Below are a few of the notable comments from the presenters on these later topics:

  1. In the long term, fee-for-service in the PAC sector is dead. Eventually, it will be replaced by managed care. Within five years every state will get out of the Medicaid fee-for-service basis and be in a managed care model. If we are looking at the future of post-acute care/growing census and market share, then we must ask what are the market differentiators to become more attractive to drive patient referrals.
  2. PAC does not (yet) have the requisite critical care pathways and the implementation of electronic medical record (EMR) is way behind. EMR needs to be established and PACs must have the ability to share the EMR with patients and hospitals as well as the ability to analyze the data. Kindred Healthcare has successfully  become a vertically integrated provider. Big question: is collaborative care coordination between separate PAC entities (e.g. long-term care hospitals, SNFs, home health agencies, etc.) a viable alternative?
  3. Healthcare has been fragmented for a very long time and hospitals can generate only so much value. PAC is positioning itself to be a great way to bring to the system: better or identical clinical outcomes at the same cost. The big question is who will be best positioned to capture that value?
  4. It is a challenge to define that patient care is high quality and continuous across the spectrum and how to organize the delivery system is unresolved. Payment drives network configuration and the system has not settled on one model yet.
  5. It is not obvious who will be the leader for the consolidation of post-acute care services. It was mentioned by one speaker that if they have leadership skills, there is no reason why a SNF could not be the catalyst to bring everyone to the table.
  6. Many of the speakers remarked that hospitals systems are challenged when managing PAC services. Hospitals are going to be looking for solutions and that will create opportunity to coordinate the patient post-discharge. The reality is that not all hospitals will come to this realization at the same time (and not all will need to).
  7. The trend of pushing down risk to the providers will continue.

In Part Two of this series, I will publish a few more highlights from the conference. To learn more, follow me on Twitter @aginginchicago.


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    The question is how to make sure everyone can be taken care of. Yes, we each own our own of whatever it is we fancy, but it should be important for ever person to watch out for his neighbor. I don't know the solution, but it's out there somewhere.

    Feruccio Lamborghini

  • In the past, I have written about the Beacon Village model, that actively promotes neighbors being responsible for one another. Unfortunately, this model tends to work best in relatively affluent communities with access to non-government funding sources. Thank you for your comment! To learn more, follow me on Twitter @aginginchicago

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    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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