If Cecily Lohmar were Regis Philbin, she might offer a million dollars for the correct answer to the question posed by her ACHE seminar: "Post-Acute Care: Why Should We Be in this Business?"
Faced with plummeting Medicare payments to home health and skilled-nursing units, hospitals chiefs might be tempted to go with the obvious reply, "We shouldn't."
But is that really the final answer?
Lohmar, a director with Northbrook, Ill.-based consulting firm Arista Associates, says too many hospitals are reacting in knee-jerk fashion to the cuts in post-acute-care reimbursement and are trimming or dumping services without adequately evaluating the options.
Her seminar, to be presented at 10 a.m. and 2: 15 p.m. Monday, March 27, is designed to encourage hospitals to use a cool head in assessing their goals and capabilities in post-acute care.
After all, would-be millionaires on Regis' show might rely on gut instinct for their answers, but that shouldn't guide hospital executives.
Once a quiet contributor to the bottom line, post-acute services have become the problem child of the hospital industry, Lohmar says.
Because most hospitals have not historically seen post-acute care as central to their business, they find it easier to eliminate it than try to nurse it back to fiscal health.
But that approach might be shortsighted, Lohmar says. Although "post-acute services came in as a discretionary service . . . it may not be a discretionary service down the road," she warns.
In many cases hospitals will find they shouldn't try to operate all the post-acute services that patients may need, Lohmar says.
But in all cases they need to evaluate solutions strategically to make sure that whatever solution they come up with is the right one, not just what's expedient.
"There is a sense of urgency for post-acute because of the payment change," Lohmar says. "Skilled nursing is already going through major payment changes, which have taken it from a very profitable service to a very questionable service in terms of profitability."
Medicare home health payments changed last year and will change again later this year, and acute rehabilitation services are slated for a new payment system in the near future.
The key to determining whether to continue offering post-acute care is for hospitals to ask why they are in post-acute care in the first place, Lohmar says.
Only then can they start to consider a few other possible answers to the million-dollar question, including "to save money on the inpatient side," "to keep patients within our delivery system" and "to serve the public good."
Since Lohmar is not Regis, however, and her seminar is not a blockbuster TV show, there are more than four possible answers.
But first, she says, you have to pose the question.