Q&A: Transitioning patients to postacute facilities

Q: Throughout the novel coronavirus (COVID-19) pandemic, case managers have faced many challenges when trying to find placements for patients who need to transfer from the hospital to a lower level of care, such as a skilled nursing facility (SNF). As we enter 2021, what challenges will persist and how can case managers work to overcome them?

A: These postacute placements will likely continue to be a pain point for case managers in 2021. Postacute placement challenges will likely be exacerbated due to other factors outside the pandemic, says Alan Cudney, MBA, MHS, RN-BC, CPHQ, PMP, FACHE, of Healthcare Impact LLC in Concord, North Carolina. These factors include a growing elderly population and an increasing number of older adults with dementia.

The challenge will be to find beds, keep patients moving through the system efficiently, and keep hospital staff members from experiencing burnout that leads to staff absenteeism and attrition, says Cudney.

To address these problems, Cudney says case managers and hospitals can take several steps, including:

• Being proactive and developing discharge plans as rapidly as possible, as well as engaging patients in that process, to help reduce avoidable days in the hospital
• Encouraging postacute facilities to strengthen their information systems and business infrastructure to become more efficient and strengthen profitability to subsequently grow staffing and expand services
• Hiring strong leaders with business and clinical acumen, along with a drive for improving healthcare
• Increasing collaboration with postacute facilities and service providers to develop rapid-cycle referral strategies and after-hours intake processes
• Making the best use of technology while maintaining prudent cost control
• Providing medical necessity screening by case managers at every point of patient entry
• Staying disciplined in the use of performance management and project management
• Strengthening the hospital case management team to be more proactive and business-savvy

For more on this topic, see January's issue of Case Management Monthly.