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How a skilled nursing facility improved readmissions, clinical quality and its finances

Vernon Manor and Manchester Manor deployed software on top of its EHR to analyze clinical data fields and recommend interventions.

Jeff Lagasse, Associate Editor

Credit: Manchester ManorCredit: Manchester Manor

Skilled nursing facilities are moving into the digital age, and the impact is being felt in areas ranging from hospital readmissions to workforce efficiency and clinical quality. Increasingly, skilled nursing facilities are using new approaches to improve not only their own performance but the wellbeing of the healthcare system generally.

"The burden of paperwork in these buildings is absolutely astounding," said Paul Liistro, managing partner of Vernon Manor and Manchester Manor, both in Connecticut. "If you can find a technological answer, it'll save you a lot of frustration. It makes the quality of work, the experience they have when they come to work, more enjoyable. They just want to solve medical problems."

[Also: Performance improvement collaboratives help nursing homes prevent infections]

Rather than stay in the paper-based environment common to many skilled nursing facilities, Liistro's facilities are moving forward into what he sees as the future of long-term care.

For two years now, Liistro has been using Real Time Medical Systems, which has been expanding its presence thanks to a partnership with healthcare distributor Medline Industries. Essentially a platform that sits on top of a facility's electronic medical record, Real Time analyzes 150 clinical data fields, provides recommended interventions and consolidates the data into a single report. It gives the two Connecticut facilities a fresh report each day at 12:01.

Now, Liistro and his staff don't have to wait until the EMR's minimum data set pinpoints a trend that's happening. That has improved clinical quality, which in turn has resulted in fewer patients being readmitted to a local hospital.

"That is a metric that is problematic, because it's very expensive for the federal government," said Liistro. "It's problematic for us and the industry because the government is now creating a program where they penalize us for readmissions, and that starts in 2018. So you have to look for solutions that are going to help you avoid those things. If you're lowering the readmissions rate, you're starting to do things better."

The two facilities have also been able to improve their patients' lengths of stay. In Connecticut, the average length of stay for a patient in a skilled nursing facility is 30 days, and by Liistro's estimate, that translates into about $18,000 a stay -- the cost of episodic care. By contrast, Liistro's buildings average about 14 of 15 days per length of stay.

"Someone sees I'm responding to the mantra of shorter lengths of stay, lower readmission rates," he said. "So what hospitals and insurance companies are going to do is send us more patients. It's been driving volume."

Hospitals aren't complaining, either. The federal government levies financial penalties against hospitals for underperforming against their peers when it comes to 30-day readmission rates; Medicare financially penalizes about two-thirds of U.S. hospitals based on that metric. Harnessing technology to improve clinical quality and reduce that metric has benefitted not only Vernon and Manchester Manors, but hospitals that serve those communities.

It's part of a broader technological approach that has helped in other areas, as well. The Connecticut facilities have been using Providigm's Abaqis tool, a quality management system distributed by Medline that helps reduce survey deficiencies, to help prepare for surveyors who come in and determine skilled nursing facilities' competencies in several key areas. When CMS announced the facility assessment requirement, Providigm decided to add an assessment tool to abaqis to provide nursing home operators with an efficient means fulfilling the requirement.

It's already paying off. By the time the surveyors come in, Vernon and Manchester Manors have typically already identified any issues that might be found, and taken steps to correct them. The two buildings routinely score a full five stars on, one of several federal websites that rank healthcare facilities on quality.

"If you can intercept that assessment, if you can know it before you complete that form, it doesn't become data," said Liistro. "You can fix it. The software technology gathers that information every night in our building. It will tell us specifically which patients have triggered something that will affect our five-star (rating)."

The efforts to bolster care and quality through technology is part of the two skilled nursing facilities' drive to follow the so-called triple aim: better outcomes, lower cost, and better patient satisfaction. There's an upfront investment required to overhaul systems and processes in a 21st century framework, but it pays off down the road.

"We spend about $325,000 on IT-related software," said Liistro. "When I tell people that, they stare at me and ask, 'Why do you have this?' The theory is, every department, and in some cases specific people, need to have a sharp tool in their shed. The software makes them do their job much better. If you're a paper-driven nursing home, you're not going to be as attractive to a new graduate nurse, because they are attracted to technology."

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