Bloomington / Normal, IL

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Understanding the Changing Healthcare System


Got questions about healthcare? Well, who doesn’t? It’s no secret that the health care system is changing. What is needed most is to change perceptions and re-educate the public about the future of healthcare.

As healthcare shifts to meet the requirements set out by the Affordable Care Act, consumers have been hit with a lot of change. What seems overwhelming, confusing, and even scary at times can usually be tempered with a little bit of knowledge. Here are some terms and adages that could use some adjustment:

Nursing home
— Ask anyone over the age of 50 what their impression of a nursing home is and the response is likely to be somewhat negative. However, that is changing. Today’s facilities are not your grandmother’s nursing home. A more common term today is skilled nursing facility or SNF, however a more appropriate term is post-acute care facility. SNFs offer patients the next level of care when they still need skilled medical attention, especially after a hospital stay.

A physician, called a SNFist,
directs the care of the patient admitted to the post-acute care facility, and sees them on a weekly basis for the duration of the patient’s stay. An APN or a PA, depending on the network, sees patients as needed. In addition, the SNFist, in conjunction with the APN and PA, are on call 24/7. This hands-on approach to care is a key difference in the delivery of care today.

This is a change from the nursing homes of old, where the doctor only saw patients once a month and RNs seemed to constantly be in short supply. Also in contrast, the nursing quality is at a very high level at a SNF — the level of nursing licensure is much higher than before. Patients and patient families can be very confident that complicated medical cases can be easily managed at a SNF, and providers are available if something happens, just like at the hospital.

Being “booted out” of a facility
— Patients may have used this term because of a lack of clear communication. It used to be that the length of a hospital stay was a mysterious mix of physician, insurance, and sometimes patient input. At some point, a decision was made and patients were discharged. Without having preset expectations, they often felt they were being “booted out” so the next patient could use the bed. Now communication about length of stay begins immediately when the patient is admitted (or even before, if the hospital stay is due to a scheduled procedure).

It’s a balance of what the appropriate length of stay is and making sure the patient is ready to move to the next level of care — setting expectations and even goals for the entire process. It’s also about making sure the patient’s information is available for the next team of caregivers.

For example, when a patient has additional needs, such as rehab, after a hospital stay, the social worker at the hospital makes a referral to the clinical nurse liaison. The arrangements are made, the medical information is passed along, and the patient has a seamless transition because the caregivers on both ends have communicated so that nothing gets missed.

Clear, proactive communication from the beginning keeps everyone on the same page regarding timing and transitions. Every transition (even if it’s within the hospital) is hard on a patient. The unknown and unfamiliar increases the stress level of the patient and the family. Good communication, especially through EMR, enables all providers involved in the patient’s care to be up-to-date on what the patient’s current status is.

Communication is essential for good managed care, and no patient should feel “booted out” with the level of communication currently in place.

“Medicare will pay 100 days” — This attitude no longer applies in today’s managed medical care environment. Within 48 hours of entering the facility, there is a plan of care with an estimated discharge date. With the goal of moving the patient to the highest level of functioning, today’s advanced surgery techniques and rehab capabilities do not require 100 days.

Expectations for the patient are based on the information provided by the skilled-care team during their weekly meetings to discuss the patient’s progress. There are no black holes of communication, no black holes of care with this system. The likelihood of falling between the cracks is practically non-existent.

Long hospital stays for routine surgeries or medical issues (e.g., cardiac, hip or knee replacement, stroke, COPD) are also a thing of the past. Most patients who do not have other complications will be released to the next level of care — such as a SNF — after just a few days. In fact, the goal is for patients to leave the hospital as soon as is safely possible (and to reduce the possibility of being re-admitted) because of the increased risk of illness and infection.

The data has shown that skilled nursing facilities decrease readmission rates and follow-up visits to the ED, decrease lengths of stay, keep better track of patient progress, and overall result in better outcomes. Care at a SNF also allows for cost savings, which helps everyone. Patients can also be re-admitted directly back to a SNF from home if necessary, thus avoiding an expensive and unnecessary hospital stay.

If you have questions about the post-acute care services provided by Heritage Health, please call Alison Skelton at 309-825-1409. She would be happy to provide information that will enable you to make the best decision for you and your family before you have an urgent need.

Terms you need to know

ACO — Accountable Care Organization — A preferred network of medical care providers that includes physicians, mid-level practitioners, RNs, and therapists at a skilled nursing facility.

APN — Advanced Practice Nurse (often called a nurse practitioner) — A highly skilled nurse who is qualified to practice medicine, diagnose, prescribe medication, and make other medical decisions for patients under the supervision of a physician.

APP — A medical provider who functions under the auspices of a physician; APNs and PAs are examples of an APP.

ECM — Extended Care Manager — The designated person who follows up with a patient to ensure that the patient’s transition to the next level of care is successful by making sure subsequent appointments are made, medications are obtained, questions are answered, and the patient is achieving goals.

ED — Emergency Department — the section of a hospital that focuses on immediate medical care due to trauma or crisis.

EMR — Electronic Medical Record — A patient’s medical information stored electronically. EMR allows higher levels of communication for a patient’s medical team as they are able to access the record immediately and have the most up-to-date information with which to make medical decisions.

Hospitalist — Physician who oversees a patient’s care while in the hospital and communicates with your PCP.

Level of care — Refers to the necessary amount of medical care that a patient needs for a particular period of time. Stepping down to the next level of care simply means that the patient no longer needs the same amount of medical supervision because their health status is improving.

Managed care — The effort of a network of providers who work together to ensure a patient successfully moves through the continuum of health care levels based on their physical needs and that each transition is smooth and successful.

PA — Physician’s Assistant — A medical professional who is educated, qualified, and certified to conduct medical functions such as physical exams, diagnoses and treatment of illnesses, order and interpret tests, prescribe medications, and other similar medical tasks.

PAN — Post Acute Network — The network of providers (including physicians, APNs, PAs, therapists, and nurses) and facilities that offer short-term intensive rehabilitation services in a skilled nursing facility.

Payor status — What your insurance covers as far as medical care.

PCP — Primary Care Physician — A patient’s “regular” doctor who oversees medical care.

Post-acute care — The medical care provided after a hospital stay either in the home or in a specialize facility

Post-acute care facility — a healthcare provider specializing in post-acute care

Preferred provider — A member of the network of providers (hospital, physicians, facilities) who fulfills the standards of care and work together to provide seamless patient care.

SNF — Skilled Nursing Facility — A facility that offers patients the level of care needed for their continued rehabilitation, usually after a hospital stay.

SNFist — A physician who monitors a patient’s progress on a weekly basis in a skilled nursing facility.