Don’t keep the doctor away!
The first Partnership is with a physician’s practice. The secret to creating and sustaining this partnership (and actually all five partnerships) is having your administrators consistently track their data and hold their partners accountable. Let me share an example.
It’s Monday morning . . . and I’m in for a surprise. I’m at my desk reviewing the data of one of our facilities where we have successfully employed the partnership model. I discover that we’ve had 14 admissions to the hospital in the past month. In this facility we normally have five hospitalizations . . . but never 14. I immediately send the administrator and the director of the physician’s practice an email asking them for an account of each hospital transfer. Then I remember. . . earlier in the month I was talking with that administrator about the fact that their nurse practitioner (NP) had resigned. When I asked the administrator about a replacement, the response was, “Don’t worry about it, Scott, we’ve got it covered.”
Well, it didn’t seem like it!
When I look at the log of the resident, I see that in the past month NP visits were only half of what they should have been in that building. There was a two-week period when the physician was still coming in but because there was no NP in the building seeing patients the number of visits per patient went down and correspondingly the number of people being admitted to the hospital went up.
Why so many hospitalizations?
Because normally when a nurse had a patient in crisis she would call the NP to come down and look at them and most of the time this would result in a changed or modified order for treatment in the facility. But with the NP gone the nurse contacted the physician who would take the easy way out. “Send the patient to the hospital to be on safe side.”
We discovered 12 of the 14 hospitalizations occurred during the two-week period when there was no NP in the building. As a result of not employing our model of care we had more than twice the hospitalizations than normal! The point is to deliver the best quality care; you must partner with a physician practice, track your data and hold the practice accountable for following the three strategies I will outline now. These strategies will ensure that your practitioners see patients frequently enough to get them and keep them well.
Strategy 1: Follow “The Rule of 12”
This may seem radical to some of you now but 20 years ago these patients would still have been in the hospital and seen daily. When we implement the rule of 12 we significantly decreased our hospitalization rate. The rule of 12 means that all of your Part A patients should be seen 12 times in a 30-day period – at least four times in the first week.
In addition we found that when we had all of our long-term care residents seen 3 times per month we reduced our rehospitalizations by 80%.
Strategy 2: Calculate and Track Practitioner Visits
Here’s how you calculate the optimum number. You’re going to take the number of Medicare residents and multiply by 12, then take your long-term residents and multiply by 3. That will give you the optimal number of visits that should be provided to your residents each month.
The optimum system to employ in your high Medicare use buildings is to have your practitioners do 12-hour shifts on an AB track system seven days a week. By employing this partnership model of care you can expect a 30 percent reduction in Medicare hospitalizations. I am convinced you willl find that this will be a compelling reason for your customers and case managers to consider you the skilled nursing community of choice.
Strategy 3: Provide Transitional Care Visits
We require our physicians to monitor patients for 30 days after discharge and to make transitional care visits within seven days. We consider this necessary because we believe it is our responsibility to keep our patients as healthy as possible and prevent their readmission to the hospital – and we can only do that by providing these visits. An added benefit is that your practitioners can bill $275 for providing that 30-day transitional care management.
You can easily achieve enthusiastic cooperation by your practitioners by explaining that if they employ these three-step strategies, you will provide them with more patient visits and help them achieve lower healthcare costs per patient, both of which will make them very attractive to ACOs. The point is providing the correct continuity of care is your responsibility and you must hold your practitioners accountable for employing these strategies.
Are Your Skilled Nursing Physicians Partners or Leaches?
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