Genesis HealthCare (NYSE: GEN), one of the largest post-acute care providers in the United States, announced that its accountable care organization, called LTC ACO, has added almost 200 unaffiliated long-term care facilities to its ACO.
LTC ACO is a wholly owned subsidiary of Kennett Square, Pa.-based Genesis and the only ACO sponsored by a post-acute care organization. In 2016, LTC ACO, formerly known as Genesis Healthcare ACO, began participating in the Medicare Shared Savings Program (MSSP) through Genesis HealthCare’s Genesis Physician Services (GPS) division. GPS has physicians, physician assistants and nurse practitioners who make more than half a million visits annually to both short- and long-stay patients.
LTC ACO said it recently welcomed nearly 200 facilities to its ACO and is in the process of contracting with approximately 200 physicians who provide services to residents in those facilities. LTC ACO added that it passes along no risk to the facilities and requires no capital outlay in order to participate. It expects to attribute approximately 3,000 additional lives by the end of 2020 associated with these new facilities.
LTC ACO points out that its structure and breadth of experience can help facilities drive improved patient outcomes and reduce rehospitalizations. In an environment where all providers are being asked to do more with less, the ACO structure allows these facilities to share financially in the improvements it makes both from a cost and quality perspective. The ACO also allows them to better align the efforts of their physicians, creating a collaborative environment to achieve these goals. This alignment is something that has rarely been accomplished heretofore in the long-term care industry.
Rich Feifer, M.D., president of Genesis Physician Services and chief medical officer at Genesis HealthCare, who leads more than 550 clinicians in the transition from fee-for-service to value-based care, spoke at the NAACOS Fall Conference in Washington, D.C., last September.
In the skilled nursing setting, Feifer said, having more nurse practitioners, physician assistants and physicians on site is key. In studying its own experience, Genesis found that evenings and weekends were a problem, because staffing was thinner. The default was to send complicated patients to the ER. “When a complicated patient hits the ER, they are going up the elevator,” he said. Genesis has worked to add a telemedicine service that allows staff to engage a physician trained in long-term care to do a patient assessment on site safely.
“Reducing unnecessary hospitalizations is central to our success,” Feifer said. “We have to identify and evaluate patients who might be decompensating by doing testing on site and getting lab results quickly, including ultrasounds. The scope of services we provide on-site now is much more complex.” He said they also spend more time talking to patients about their goals of care. “For many people, we find that their preference is to be cared for on-site rather than being transitioned to the ED. Hospitals can be dangerous places. Sometimes bad things happen. They want care in a more nurturing setting sometimes.”
Feifer also noted that there has been a dramatic reduction in average length of stay, and goals of rehab have changed. “Previously they had a goal of restoration of function before returning home. It is different now. Now they say the goal is to get you well enough to go to next level of care, which is outpatient care,” which is good, he said. “But as length of stay gets shorter, in some cases, we see increases in rehospitalizations, and that concerns us, because we are directly penalized. We have to find that balance.”
