Unlike home health and other post-acute sectors, to date skilled nursing operators and hospitals have not entered into many joint venture partnerships. Yet the COVID-19 pandemic may have been the wakeup call hospitals and skilled nursing facilities needed to consider more integrated relationships that strengthen alignment, according to speakers Wednesday at a National Investment Center for Seniors Housing & Care “Leadership Huddle” webinar.

One of the continuing trends of the pandemic has been an almost 25% decrease in hospital discharges to SNFs, noted Andre Maksimow, senior vice president at the healthcare management consultant firm Kaufman Hall, and the NIC panel’s moderator. The reality, several speakers noted, is that COVID-19 has led to a fundamental shift in how hospitals view post-acute discharges.

“Before COVID, we always asked what level of care a patient could qualify for when planning for discharge,” said Mark Terpylak, D.O., senior vice president of population health at Summa Health, a nonprofit integrated healthcare delivery system in Northeast Ohio. “Now we ask ourselves, ‘Can we send this patient directly home and support them in a home environment?’ ” In cases where the hospital can’t send a patient directly home, the system looks to send him or her to one of its preferred network skilled nursing operators — operators who “share Summa’s values and will provide that care in the most cost-effective manner,” Terpylak added.

David Dafilou, vice president of Pennington, NH-based Capital Health System, agreed, noting that he’s not certain the percentage of hospital-SNF discharges ever will return to pre-COVID numbers. 

“Patients would much rather go home, and as we start to see some good results from that, it’s been creating a buzz within the healthcare system,” Dafilou said. He noted, however, that Capital Health has narrowed itself to a network of eight partner SNFs, from 12 earlier this year. The ones that remain on the list are those with which the health system has been able to find the most alignment in terms of facilities that are managed by people who are forward-thinking, and who allow Capital’s nurse practitioners to round at the facilities, as a way to enhance communication.

“Those SNFs that step up their game to do more of what we need should expect more volume from us in return, and that’s perfectly fair,” he said.

So although it seems that where the ultimate destination has shifted more to home, at the end of the day, the overarching theme really is about where patients can receive the highest quality of care for the lowest total cost of care, said Brian Cloch, principal at Innovative Health. In the end, he noted, it may come down to readmission rates. 

“If you end up with a higher readmission rate from patients going to home health, from a dollar and cents perspective, a 15-day stay in a skilled nursing facility is going to be a better investment than home health,” Cloch said.