CE1
Approved for 1 hour of CCM, CDMS, and nursing education credit Exam expires on October 15, 2022
Pandemic Era Developments for Postacute Care Networks: Part II Laura Kukral, MBA, LNHA, and Ben Frank, MHA, FACHE
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ostacute care networks (“networks”) are changing in response to the impacts of COVID-19. These changes include network structures, size, membership, goals, and use of technology. One of the most notable changes is the inclusion of “super skilled nursing facilities (SNFs)” to provide integrated specialty care modeled after hospital-based service line best practices.
What is a Service Line?
A service line is an organizational and managerial model that follows the patient’s path through the care process to provide and integrate all the services they may need for a medical condition (eg, cardiac care) at a single location or set of locations. Hospital service lines emerged in in the 1990s in response to the demand for integrated care and the need for caregivers to “cut across both institutional and disciplinary boundaries to organize patient care around specific diseases, interventions or populations” (Charns et al., 2001). Before service lines, patients found that hospitals offered a piecemeal system of care with many siloed physicians and departments. Laura Kukral, MBA, LNHA, is a consultant in healthcare strategic planning and innovation. She has 30 years’ experience helping health systems, postacute providers, and community-based organizations with growth and innovation planning. She is currently the President of S-gen Marketing, LLC, and is a go-tomarket and innovations advisor for 3AimPartners, LLC, and SciMedi, LLC. She can be reached at LauraK@s-genmarketing.com. Ben Frank, MHA, FACHE, is Chief Executive Officer at 3AimPartners, LLC, a healthcare consultancy focused on improving patient experience, the health of populations, and cost of care. Ben previously served as the Market President for Chen Medical, System Chief Operating Officer and Chief of Staff for Inova Health System, and System Executive Director of Clinical Operations at the Cleveland Clinic. He can be reached at Ben@3aimpartners.com.
When Johns Hopkins Medicine moved to the model, it was described as a sea change in patient care with the expectation that patients could call a single phone number and enter the system at the right place and into a care path that was more efficient and effective (Blum, 2017). Service lines were established as strategic collaborations between physicians and hospital managers, with physicians designing the clinical process and managers providing day-to-day oversight (Becker’s Hospital Review, 2012). While health systems historically focused on organizing care (and service lines) inside the walls of the hospital, programs such as Medicare’s Value-Based Purchasing Program, Hospital Readmission Reduction Program, and Bundled Payment Care Initiative (BCPI) established incentives for collaboration with providers across the entire continuum of care, notably postacute care providers. Hundreds of hospitals and physician group practices initiated BPCI Model 2 agreements that bundled payments for a Medicare beneficiary’s hospital inpatient stay and all postacute care (CMS, 2022) and gained experience in coordinating care with SNFs. These early collaborations frequently identified preferred providers and created shared care paths. They generally did not result in integrated service lines and strategies because of a variety of obstacles including strategic priorities, organizational culture, and limited understanding of the rules and regulations required at various levels of care as well as disparate data sources, lack of governance and legal structure, and questions about funding, availability of staff and equipment, and costs of care.
Service Lines Across the Continuum of Care
Despite development challenges, specialty programs have a long history in skilled nursing (Marselas, 2021). Notably, the COVID-19 pandemic seems to have created more specialty and service line partnership opportunities for postacute care providers and hospitals, “especially for those who can demonstrate prowess with cardiac, pulmonary, renal failure, sepsis and neurologically impaired patients” (Marselas, 2021). According to PointRight, a data analytics company, the skilled nursing industry experienced a nearly 5x increase in April/May 2022 CareManagement 11
