In my community, our traditional source of providers for caring for our SNF patients has been dwindling for the past several decades as private physicians and new graduates moved into outpatient practices through hospital medical foundations.  Occasionally, older physicians have left their office practice or their foundation employer for the lower cost and flexibility of a dedicated PA/LTC practice.  However, that requires good business skills to navigate the various insurance contracts, on-call support, billing service, EHR platforms, MIPS reporting options, and triage of calls/faxes/texts from various facilities.  As I look at my community, I foresee this workforce of providers continuing to dwindle.  

For this reason, I contacted a large local non-profit hospital CMO about becoming more invested in SNF care, and this led to an interesting conversation with their foundation CMO.  This CMO shares my concerns regarding the very thin provider base in our SNF community and its potential adverse effect on the ability of SNFs to accept post-acute care patients as well as to effectively and efficiently manage them.  This CMO is very much aware of the aging physician workforce in our state where about 35,000 of the 145,000 licensed physicians are > 65 y/o (2020-2021 Medical Board of CA Annual Report).    

This foundation already has preferred SNFs for post-acute care and at risk contracting (e.g., Total Joints), but apart from the LOS (length of stay) metric, doesn’t have much impact on the efficiency or effectiveness of the care provided at these SNFs.  If the foundation were to jointly provide their EHR (EPIC) for the providers in these facilities, this could improve the efficiency of provider care, since the provider could easily access a new admission’s hospital and office records, pull that into their notes, and focus on the current clinical issues.  This could also facilitate medication reconciliation on admission and allow time for important care conversations with patients and their families.  The patient portal could also improve efficient access to the PCP/Provider Team by the patient or their trusted health care advocate.  

Our local Kaiser Permanente Continuity of Care Team has used this EPIC platform and care processes for many years as their standard of care in their contracted SNFs.  As a Medical Director in multiple facilities, I’ve observed facilities’ efficiency and quality of care metrics improve as the KP team introduces their care processes into the partnering facility.  The use of EPIC permits much more granular quality metrics (analytics) than is currently possible with a facility's non-aligned care providers. In addition, their team approach allows their physician provider to focus on the more complex medical care issues while deferring the more routine issues and discharge planning to the rest of their team.  This approach also supports a robust discharge process with mandatory medication reconciliation, e-prescribing, discharge summary, routing of this information to outpatient providers, and appointments for follow up set up prior to discharge home.  

The investments I have proposed may not make economic sense to foundations or SNFs at this time, but as our workforce ages, the Medicare Advantage enrollment grows, and the ability of teams to stretch physician impact and quality becomes more evident, I predict, and hope that many more medical foundations will be partnering with SNFs through shared technology and team strategies.  

Is it time for you to start these conversations in your community?