“Safe discharge”: Challenges in balancing care and costs in value-based care in nursing homes

Reimbursement challenges in nursing homes are forcing operators to adapt their payment models and rely more heavily on Institutional Special Needs Plans (I-SNPs) and Accountable Care Organizations (ACOs). While these models aim to improve the quality of care while controlling costs, they also bring unique challenges, including the need for additional control over discharges and associated administrative burdens.

Operators said these value-based care options can sometimes be difficult to manage and require strategic planning and coordination from the clinical team right from the enrollment phase, but when done well, it can pay off.

Julie Britton, chief clinical officer at Genesis HealthCare, said that I-SNP and ACO participation has made care more efficient and cost-effective overall in her organization, but that such value-based care can sometimes be difficult to manage.

“Our centers have a triple goal of providing safe, efficient and cost-effective care,” Britton told Skilled Nursing News. “The introduction of I-SNPs and ACO memberships has streamlined processes for our staff.”

Genesis HealthCare’s subsidiaries include more than 200 nursing homes and senior living communities in 19 states across the country. Genesis also provides rehabilitation therapy at more than 1,400 locations in 43 states and the District of Columbia.

Delena Stortz, chief nursing officer at Consulate Health Care, said that while ACOs and I-SNPs have advantages, the challenges of managing care under these models require extra vigilance. And to ensure safe and appropriate discharges, her organization must regularly negotiate more time to achieve optimal outcomes.

“We’re definitely involved with those types of ACOs and I-SNPs in our buildings, (but) it’s difficult to navigate sometimes because (those programs) require residents to stay for shorter and shorter periods of time. So it’s a struggle because we want to make sure the discharge is safe and appropriate,” Stortz told SNN. “And we really have to go back to that provider and say, ‘Wait, we need more time.’ And yeah, it’s definitely a struggle.”

Consulate Health Care is a leading national provider of senior health services specializing in post-acute care. With offices in Pennsylvania, Virginia, North Carolina, Mississippi and Louisiana, the company offers services ranging from comprehensive short-term rehabilitation and transitional care to Alzheimer’s and dementia care..

All-round support from the start

Meanwhile, John McFarlane, Chief Medical Officer of Ignite Medical Resorts, explained that as part of these plans, it is critical to provide a complete clinical picture from the outset to support successful outcomes, as missing pieces could impact the length of a resident’s stay in a facility.

“We just try to do our best when we work with I-SNPs and ACOs, especially when it comes to providing a really comprehensive clinical picture of what’s going on with the particular resident so they have the best chance of success,” McFarlane told SNN.

Discharge from the SNF too early increases the risk of readmission and thus perpetuates a costly cycle, he said.

“Our facilities are aligned with the hospital’s goal of not having that resident go home, only to return to the hospital and go through the whole cycle over and over again,” McFarlane said.

Ignite Medical Resorts combines advanced medical rehabilitation with the first-class hospitality of a 5-star luxury resort. Based in Park Ridge, Illinois, the company has 20 facilities in seven states, including Illinois and Texas.

Interdisciplinary care as the key to success

Executives said the transition to value-based care models can be difficult when it comes to balancing cost and quality, but Ignite and Genesis have established a process that applies from the beginning of a resident’s stay at their facilities.

“It’s challenging. We focus on comprehensive, interdisciplinary care planning at admission and ensuring residents and families are well informed about their condition and care options,” McFarlane said.

To avoid treatment issues related to VBC at Genesis, proactive measures to align treatment goals with patient needs early on are an absolute must, Britton said. Genesis does this in a complex way.

“We discuss medications, equipment needs and scheduling in advance,” Britton said. “It’s critical that our staff understand how to provide safe, efficient and cost-effective care.”

Regarding Consulate Health’s recipe for success for VBC, Stortz also emphasized the interdisciplinary approach to discharge planning, which aims to achieve consensus between caregivers and families.

“Aligning goals ensures a safe transition home,” Stortz said. “Cost considerations are important, but they should never compromise clinical judgment or patient outcomes.”

These strategies reflect a broader shift in the industry toward integrated care models that focus on patient outcomes and cost containment.

However, challenges remain. The pressure to shorten stays under these models requires careful management to avoid early discharges.

As nursing homes adapt to these new payment structures, collaboration with hospitals and community providers becomes critical.

McFarlane stressed the importance of adapting to hospital systems to enable smooth transitions and avoid unnecessary readmissions.