Like it or not the Facility - Medical Practice Relationship is changing

Introduction: The landscape of post-acute/long-term healthcare is undergoing a significant transformation with the emergence and growing traction of value-based payment programs initiated by Medicare. As skilled nursing, long-term care, and assisted living (PALTC) facilities navigate this shifting paradigm, there is an urgent need to reevaluate their relationship with the medical practices that provide professional medical services to their residents. Traditionally siloed, the relationship between facility operator leadership and medical practice leadership must evolve into an integrated partnership. This article delves into the imperative for PALTC facilities and medical practices to establish new day-to-day operating relationships to effectively respond to Medicare's value-based payment initiatives.
 
The Challenge of Value-Based Payment: Medicare's transition towards value-based payment programs signals a fundamental shift in healthcare reimbursement. Unlike the traditional fee-for-service model, value-based payment incorporates quality of care and patient outcomes. PALTC facilities and medical practices are now mutually accountable for delivering patient-centered care that not only promotes optimizing resident health and mental well-being but requires service delivery in a model that reduces overall costs associated with this patient population to receive program bonus payments.
 
Breaking Down Silos: Historically, PALTC facilities and medical practices have functioned independently, with limited collaboration beyond clinicians and facility leadership. This siloed approach impedes seamless care coordination focus on aligned goals and can result in lost quality and financial opportunity for both parties. As value-based payment programs take center stage, it is imperative to bridge the divide between these entities to provide medical and residential services that meet resident/family needs, meet, or exceed survey standards and result in everyone’s’ financial success.
 
The Case for Integrated Partnerships: 

1. Enhanced Patient Outcomes: Collaborative partnerships enable PALTC facilities and medical practices to work cohesively towards achieving superior patient outcomes. Streamlined communication and shared data facilitate informed decision-making, reducing the risk of medical errors and enhancing recovery rates.

 

1. Continuity of Care: An integrated approach ensures a smooth transition for patients as they move from acute care settings to PALTC facilities and beyond. This continuity of care minimizes disruptions and enhances patient well-being.

 

1. Optimized Resource Allocation: By working together from the same operations plan that shares insights and expertise, medical practices and PALTC facilities can optimize resource allocation. This can include improved staff scheduling, fewer unnecessary emergency department and hospital transfers, and judicious use of company and practice resources.

 

1. Preventive Care Focus: Integrated partnerships encourage a proactive approach to healthcare. By collaborating on focused measures and wellness initiatives, medical practices and facilities can optimize Medicare and other payor reimbursement.

 
 
Building Integrated Operating Relationships: 

1. Open Communication Channels: PALTC facilities and medical practices must establish clear communication channels to facilitate the exchange of patient information, treatment plans, and progress updates. Well-planned meetings reviewing key performance metrics and joint case reviews can foster mutual understanding.

 

1. Shared Data and Technology: Optimizing the use of interoperable electronic health records (EHR) systems allows for real-time access to patient data, enabling informed decision-making and more appropriate care delivery.

 

1. Joint Care Planning: Collaboratively develop care plans that span medical, rehabilitative, and psychosocial aspects. This approach ensures a comprehensive approach to patient well-being and efficient operations.

 

1. Staff Training and Collaboration: Train staff from both medical practices and facilities to understand each other's roles and responsibilities. Joint training sessions can foster a culture of collaboration. While mutual morale building should be an outcome of this initiative, the primary focus is to identify and implement changes in behavior that achieve improved results.

 
The Role of Leadership: Effective integration requires leadership commitment from both PALTC facilities and medical practices. Leaders should initiate and nurture collaborative efforts, setting the tone for a unified approach to patient care.
 
Conclusion: As Medicare's value-based payment programs reshape the healthcare landscape, PALTC facilities and medical practices must respond with innovative, patient-centered strategies. The traditional siloed relationship between facility operator leadership and medical practice leadership is no longer sustainable. By forging new day-to-day operating relationships that prioritize integration, open communication, and shared goals, these entities can deliver the quality care and financial outcomes that the evolving healthcare ecosystem demands. Through collaboration, PALTC facilities and medical practices pave the way for a brighter and more integrated future in healthcare delivery.