Post-acute providers are eager to show hospitals how they can help with a Medicare payment demonstration model that goes into effect early next year.
Compassus, Elara Caring, ArchCare and other post-acute providers said careful coordination of patient care from the hospital through the post-acute system is essential for hospitals to succeed in the Transforming Episode Accountability Model, or TEAM. Home health companies and skilled nursing facilities are gathering data on patient outcomes, adding staff, enhancing technology and taking other steps to prepare for the Centers for Medicare and Medicaid Services’ program set to launch in more than 700 hospitals Jan. 1.
Related: Hospitals seek post-acute partners for Medicare TEAM Model
Home health companies and skilled nursing facilities that become more adept at handling high acuity patients by partnering with hospitals on TEAM could become post-acute providers of choice for other health systems, Brian Fuller, managing director at healthcare advisory firm ATI Advisory, said.
Under TEAM, hospitals will get paid a set amount for 30-day care episodes around five surgical procedures, including the inpatient stay or outpatient procedure and post-surgical services. Post-acute services are expected to account for up to 60% of spending associated with the procedures, according to ATI Advisory.
Post-acute providers will not participate directly in TEAM, but they can negotiate contracts with hospitals to share in the risk and rewards of the program. CMS is encouraging hospitals to collaborate with post-acute providers and enter into gainsharing agreements with them.
Some patients undergoing one of the five surgeries — lower-extremity joint replacements, femur fracture surgeries, spinal fusions, coronary artery bypass grafts and major bowel procedures — will require a combination of skilled nursing and home healthcare, while others could be released directly to home healthcare, Fuller said.
“We see those in post-operative orthopedic conditions as common candidates for home health consideration over skilled nursing. However, that will also depend on the individual patient needs,” he said.
Providers that offer hospitals an array of post-acute services and can help reduce costs will have an advantage in TEAM, Fuller said.
ArchCare hopes to be among them and began a campaign to showcase its services several months ago.
The nonprofit operates seven skilled nursing facilities and a home health unit in the New York metropolitan area. Last fall, ArchCare began touting its track record to local hospitals participating in TEAM, including Hospital for Special Surgery, Northwell Health's Lenox Hill Hospital and New York Presbyterian Hospital, said Jason Hutchens, senior vice president of residential services.
He said ArchCare’s Mary Manning Walsh Nursing Home and Rehabilitation Center already has experience treating patients with lower-extremity joint replacements, femur fracture surgeries and spinal fusions through a partnership with Hospital for Special Surgery.
Hutchens said the four-year collaboration not only prepared ArchCare for the types of patients treated under the TEAM model, but armed the nonprofit with data on how it could help hospitals hold the line on patient costs.
“Our rehospitalization rate is 4% or below and our length of stay is between five and seven days,” Hutchens said. “When TEAM rolls out in 2026, we are going to be well positioned to work with HSS and we think the other hospitals have enough volume to help us support this model.”
Hutchens said ArchCare's collaboration with Hospital for Special Surgery also helped it predict when surgical patients will leave skilled nursing, enabling the provider to start planning patient transitions to home healthcare before they leave the hospital.
Others are jockeying for position by enhancing post-acute offerings that could help hospitals participating in TEAM save money by avoiding nursing homes entirely.
Brentwood, Tennessee-based Compassus is looking to expand a skilled nursing at-home program it launched last year in Austin, Texas, said Jordan Holland, Compassus senior vice president of value-based care. In-home skilled nursing programs offer services similar to those provided in traditional nursing homes, but are usually less expensive.
Holland said the company wants to offer the program, as well as home health services, in markets where Compassus has joint ventures with Cincinnati-based Bon Secours Mercy and St. Louis, Missouri-based Ascension. The health systems have hospitals participating in TEAM in Florida, Ohio and Tennessee.
He said Compassus is also preparing for TEAM by adding staff, increasing training for nurses and investing in technology that will connect its electronic records system to hospital EMR systems.
“Think about it as building out the piping between electronic medical records systems,” Holland said. "We can send a plan of care directly from our EMR to their EMR so that their providers can read it, sign the order and communicate it back [electronically].”
Home health company Elara Caring is also keen to work with hospitals participating in TEAM across the 18 states where it offers services, according to Justin Steele, Elara Caring senior vice president of growth. Steele said partnering with providers on other value-based care initiatives, such as the Accountable Care Organization Realizing Equity Access and Community Health, prepared Dallas-based Elara Caring for TEAM, especially from a staffing perspective.
He said the company is looking to deploy more remote patient monitoring equipment in markets with hospitals participating in the demonstration. Steele said Elara Caring is collaborating with health systems and nursing homes to ensure patients can move quickly and seamlessly from one care setting to the other.
“It’s easy for a hospital to say a skilled nursing facility must discharge a patient on day 17, but if the home care providers can’t accommodate that, it’s not the skilled nursing facility’s fault,” Steele said. “We will have to step in and educate the hospitals about that.”
Correction: An earlier version of this story incorrectly identified Jordan Holland as Compassus vice president of value-based care.
