Managing Episodic Length of Stay (ELOS) in skilled nursing facilities (SNFs) is an important strategy to reduce unnecessary costs and improve outcomes during a patient’s episode of care. It is well established that SNF length of stay varies widely between geographic regions and by payer type (fee for service vs. managed Medicare, for example). This variability is perpetuated by a lack of accessible, standardized information about expectations, performance, and outcomes. The SNF Episodic Length of Stay (ELOS) Guidelines seek to address this issue by offering clinical recommendations and data-driven targets for managing SNF length of stay at the bundle level.

One of the most important changes spurred by the practice of value-based care is how physicians may adjust the way they practice. Much of the opportunity to improve value lies in removing needless spending during the period following a hospitalization. For patients, this means spending more time recovering at home and less time in facilities. So what do doctors need to do differently to enable a home recovery?

Hospital-based specialists, generalists (e.g., hospitalists), and surgeons participating in bundled payment programs have tremendous influence over the quality and costs of patient care inside the four walls of the hospital. While many interventions also have effects after discharge, others have more limited post-acute impact. All things being equal, physicians should focus their in-hospital efforts on practices that have a positive effect on patients after they leave the hospital. For example, holding goals of care conversations, early mobilization, prompt discontinuation of urinary and central venous catheters, and asking discharge planners "Why not home?" are but a few of many practices that may improve healthcare value during the post-acute period. In the linked article, I describe how practices that represent 'thinking outside the DRG', or outside the inpatient stay, may improve patient care during recovery from a hospitalization.

Industry publication Fierce Healthcare shared Dr. Win Whitcomb’s strategies for post-acute care in an article published on October 3, 2016 that recapped Dr. Whitcomb’s panel at the CAPG Colloquium 2016.

Dr. Win Whitcomb, Remedy Partners Chief Medical Officer, was featured on a panel at the CAPG Colloquium 2016 held from September 29 through 30 in Washington, DC. CAPG is the leading U.S. trade association for and the voice of accountable physician organizations.

Selecting the optimal next site of care (NSOC) after hospital discharge has emerged as a core skill for physicians in the era of value-based healthcare. The challenge is that few of us have received formal training in post acute care site selection. When I meet with physicians and discuss NSOC selection, they express a clear desire for guidance on discharge planning as they work with patients, caregivers and the healthcare team. Here is a framework to assist physicians in post acute care selection within the BPCI program. 

A key element of discharge planning - the selection of the next site of care - is more important and more complex than ever before, due in large part to the advent of the BPCI program and the episodic approach to care. Once the realm of laminated checklists, frayed brochures and quick conversations, hospitals are now finding technology to be a powerful tool to assist them in the selection of an appropriate next site of care.

Gene Huang, Remedy Partners’  Vice President, Business Development, was a featured speaker at the 13th Annual HealthMEDX User Group in St Louis on April 12 - 14, 2016.