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    The digital disconnect in post-acute care

    As the medical director of a nursing home, Kenneth Kubitschek, MD, an internist in Asheville, North Carolina, gets called occasionally about patients he’s never seen. Perhaps a patient has just been transferred in, and he’s asked to sign off on the orders written by the hospitalists.

    The problem, he says, is that without an electronic link with the hospital, all the nurse in the skilled nursing facility can do is fax him the orders – without any context for the cases.  

    “I’ll go through the medicines and hope that the discharging physicians had it all correct,” he says. “It’s like any pass-off, you have to hope that the person passing the baton is doing a good job.”

    The quality of care would improve, he argues, if there were better online communications between hospitals and skilled nursing facilities. 

    Most nursing homes and other post-acute-care (PAC) providers, including rehab facilities and home health agencies, are still in the stone age of information technology, experts say. But health care reform is forcing PAC providers to computerize and compelling hospitals to prioritize information exchange with nursing homes and home care agencies.

    When physicians are able to access vital data across these care settings much faster than they do now, they will find it easier to care for patients recovering from hospital stays and dealing with complex illnesses, observers say.

    “If physicians have improved access to [PAC] data, hopefully they can make better decisions and can provide more efficient care for the patient and can improve transitions and outcomes,” says Mike Seiser, director of the healthcare practice at Chicago-based Huron Consulting Group. “As they move to value-based care and population health, they will need that kind of data.”


    Why PAC providers lag

    Experts agree that PAC providers trail acute and ambulatory care providers in health IT by a wide margin. 

    One reason PAC providers lag is their lack of resources, says Jonathan Baker, FACHE, managing director of the healthcare solutions practice at consulting firm KPMG. He assigns part of the blame to the exclusion of PAC providers from the government’s EHR incentive program, which has deprived these providers of funding to upgrade their health IT systems. 

    There are signs of change, however. The Meaningful Use program has provided an incentive for hospitals to send electronic care summaries to skilled nursing facilities and home care agencies. In addition, cooperation with PAC providers can help reduce readmissions, for which the Centers for Medicare & Medicaid Services (CMS) financially penalizes hospitals. And some healthcare systems recognize that post-acute care holds the key to controlling costs under bundled-payment arrangements.  

    “In areas like mandatory bundled payment pilots, hospitals are making meaningful attempts to enable bidirectional exchange of data with post-acute facilities,” notes Greg Kuhnen, director of research for Advisory Board., a Washington, D.C.-based consulting firm.

    Studies show that most of the variability in cost for bundled procedures stems from post-acute care, notes Kuhnen. Therefore, he says, it makes sense for hospitals in bundled payment arrangements to exert tighter control over what nursing homes are doing. To do that, they need data to make the nursing homes’ activities visible.

    In some cases, he adds, PAC facilities owned by or closely affiliated with a healthcare system will piggyback on the health IT infrastructure of that system. That gives nurses in skilled nursing facilities, for instance, the ability to view hospital information online.

    Seiser thinks that some healthcare organizations might start to subsidize health IT purchases by PAC providers. He doesn’t believe, however, that the government will cough up any more EHR incentive funds.

    Meanwhile, PAC facilities are consolidating into larger entities, and hospitals are acquiring skilled nursing facilities and home care agencies, Seiser points out. As a result, more PAC providers will gain the resources to invest in health IT. At the same time, independent PAC organizations will have to computerize so they can compete for referrals from hospitals.

    “If they want to be a good partner as we move toward population health management, they’re going to have to improve their ability to communicate online with hospitals, or they won’t be chosen as a partner,” Seiser says.


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