SNF@Home Means More Options for Quality, Lower-Cost Care | myNEXUS®

06 . 11 . 2020

SNF@Home lower cost

As we have discussed in previous articles, home care has proven to be a viable option for avoiding the skilled nursing facility during the COVID-19 pandemic. For the right patient, more intensive skilled care in the home has proven to deliver equivalent clinical outcomes to institutionalized care, is less resource-intensive, and is less costly. Given this, is there any reason to revert to pre-COVID-19 practice patterns once the pandemic is under control? myNEXUS believes that the answer is no. We believe that sophisticated home care providers can continue to deliver institutional-level skilled care in the home for the right patient. Of course, to replicate skilled nursing facility care in the home, home care agencies would have to deliver a higher level of care than traditional home care.

What Does a Higher Level of Care Look Like?

Our vision of “SNF@Home” would include a care transition process that:

  1. Begins in the hospital (ideally face to face), the start of home care on the day of discharge
  2. Routine use of telemonitoring
  3. “Front-loading” of skilled care visits during the early part of the post-acute care episode
  4.  24/7 mid-level or independent practitioner coverage.

Furthermore, to scale such an approach, identification of the right patient for SNF@Home would require a repeatable and systematic identification process that would begin while the patient was still in the hospital. Such a process would require access to the hospital’s daily census or ADT data, clear clinical criteria for patient selection, and coordination with the hospital’s discharge planners.

Tracking Progress

As with any new clinical endeavor, process and outcome metrics would need to be tracked. While there are many indicators that could be measured, a few that are the most relevant to this new approach include:

  • Patient demographics
  • Number of IP discharges managed at home by diagnosis and clinical status
  • Number and type of emergent interventions by the clinical team while the patient is being managed at home
  • Complication rates
  •  ER visit rate
  • Readmission rate
  • Patient satisfaction
  • Post-acute care cost

Support Within the Industry

This vision of SNF@home has received support from the home care industry. Recently, William A. Dombi, the President of the National Association for Home Care and Hospice providers was quoted as saying “We have designed a [SNF-at-home] benefit to give individuals on the Medicare program the option of going home with expanded services,” (Famakinwa, Home Health Care News, October 19, 2020). Furthermore, our SNF vs. home care cost and outcome analysis suggests that for the appropriate patient, a post-acute episode of care delivered at home would result in a significantly lower total cost of care. Our analysis is supported by a claims-based retrospective cohort analysis published in 20191. While readmissions were higher for patients managed at home, mortality and functional outcomes were not different and costs were lower. Of note, this encouraging outcome did not include validated patient selection criteria. We believe that had such criteria been available, home care readmission rates would have been equivalent to or lower than SNF level care.

In summary, we believe that high-performing home health care agencies are well-positioned to manage a subset of patients at home who previously would have been managed in a SNF. Furthermore, the literature and the industry support this perspective and the anticipated favorable clinical and cost outcomes. However, to scale such an approach, this new discharge process would need to be coupled with an enhanced home health plan of care and would need to be in place first. To read more on the cost of home care and what future solutions to high costs and high readmissions might look like, check out our previous article in this series.

Sources: 

  1. Werner RM et al. Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility. JAMA Intern Med, 2019;179(5):617-623.