Sending a patient from a hospital to a post-acute care setting is like sending them into a “black hole.”
That’s the stark assessment of one respondent to a July survey of New England Journal of Medicine (NEJM) Catalyst Insights Council members. The survey focused on current struggles in the post-acute care continuum, particularly related to staffing, with respondents identifying skilled nursing facilities as having the steepest challenges in this regard.
An “integrated and seamless method of communication” should be demanded by providers on both sides of care transitions, but staffing shortages have effectively siloed care settings, one respondent said, according the “Insights Report” on the survey.
The lack of communication was also highlighted by the respondent who made the black hole comparison.
“Discharging a patient to any long-term care facility is like sending them to a ‘black hole,’ due to the absence of continuity in the plan of care and no method for communication between providers. The current EMRs must be adapted to create a single patient record independent of location,” the clinician said.
And, when the patients return to the acute care setting from a long-term care facility, “It’s as though the diagnoses, plan of care and other patient-centered goals of care were ignored or forgotten,” the same respondent noted; a safe discharge has “rapidly become a huge challenge and ethical dilemma.”
About 61% of U.S. respondents in the NEJM survey said a lack of communication and collaboration across the care continuum is a serious problem. NEJM surveyed clinicians, clinical leaders and organization executives on a global scale that are directly involved in care delivery. Findings from 867 surveyees were compiled in the survey, with added commentary and context provided by Dr. Thomas Schaaf, chief medical officer for Providence Home and Community Care in Washington – 499 respondents were U.S.-based.
Globally, 94% of respondents said lack of communication and collaboration in inpatient, outpatient and post-acute care is a moderate or serious problem.
About 68% of U.S. respondents said staffing shortages were a top challenge facing post-acute care organizations, while 46% said patient handoffs from acute care settings to post-acute care was the second-biggest challenge, followed by organizational structure and management, health information technology and reimbursement models.
A higher percentage of U.S. respondents cited that staffing shortages and organizational structure and management in particular are causing issues for proper workflow.
In terms of patient care, a higher percentage of U.S. respondents also said staffing shortages are impacting access at 92%, patient experience at 91% and clinical quality at 88%.
The survey broke down staffing concerns among post-acute care settings as well, with 89% of U.S. respondents saying it’s a moderate to serious concern among skilled nursing facilities. By comparison, 82% consider staffing shortages in home health to have the same level of concern, then 78% and 76% for long-term care hospitals and inpatient rehabilitation facilities, respectively.
“Post-acute facilities really do not address patient care needs. The services seem to be custodial rather than really patient focused. People languish in these facilities and there is really no effective care happening,” another respondent said. “Trying to transfer an acute care patient out to some type of post-acute facility is complicated by all sorts of criteria, regulations, staffing shortages, and available beds for any kind of service.”
Another section of the survey delved into risk-based reimbursement, a model seen among many value-based care frameworks in the United States. About 34 respondents from the United States said this type of reimbursement is important for the long-term success of post-acute care.
“Align the reimbursement and payments for post-acute care providers with the acute care providers in a single continuum of care model that shares the accountability, responsibility, risk and outcomes,” another clinical leader said.
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