Perspectives on the Acute Care Continuum
The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
Sniffing Out Solutions in Post-Acute Care
Skilled Nursing Facilities (SNFs, often referred to as “sniffs”) provide an added dimension of care that can positively impact important patient metrics, including both length of stay and readmission. The prevention of readmission is receiving increased attention as the Affordable Care Act requires that in 2013, Medicare will penalize hospitals for what it deems as “excess readmission”. As a result, increased attention is being paid to the work in this post acute care setting that can be critical to reducing readmission. Statistics form HCUP (Healthcare Cost and Utilization in the United States) estimate that 13% of all patients are discharged to SNF’s and other long term care facilities. I started working with a SNF in February of this year and have seen up close the continuity of care that is provided.
SNFs are funded by Medicare and the distinction between a SNF and a “non-skilled” nursing facility are services such as occupational therapy, physical therapy, speech therapy, tube feeding, and treatment with antibiotics. There is a greatly improved quality of care when these skilled beds are available to patients. In being able to continue the level of care that would also happen at the hospital, I am able to help patients in and out of the hospital setting, an emerging hospitalist field referred to as “extensivists”. My hospital, Doctors Medical Center in San Pablo, provides me the opportunity to supplement my practice as an on-site hospitalist by also treating patients on-site at a SNF. I do think that being able to treat patients in both the hospital setting and at SNFs improves the quality of care and can prevent hospital readmissions and also get them home faster.
This has also been backed up by research when looking at the work of hospitalists when they treat patients outside of the hospital. The Agency for Healthcare Research and Quality reports that hospitalists who expand their role as extensivists can reduce readmissions and lower length of stay for high-risk patients. These researchers found that with the participation of extensivists, the average length of stay became d 3.2 days, down from 5.8 days for typical Medicare patients. They also found that 30-day readmission rate averaged 13.4%, compared to 16% before implementing the extensivist model.
SNFs are an example of the Acute Care Continuum “kicking in” for both the patient and for the healthcare challenges of the future. PCPs can stay in their office and patients can more conveniently get the treatments they need, at a price to the system which is much less than a hospital stay. I feel more comfortable releasing patients from the hospital knowing they have this option, and at the same time the data shows that they are much less likely to be readmitted with the use of SNFs.