ACOs and Us

More attention is being paid to the role of the skilled nursing facility (SNF) as accountable care organizations (ACOs) are introduced as part of the Affordable Care Act. The purpose of SNFs is to save money through the coordinated delivery of services for an episode of care, such as an elective total hip replacement or the treatment of congestive heart failure. In these cases, a bundled payment may include the services of the hospital, physician, home care, and SNF, or some combination of those providers.

Since one of the keys of an effective ACO is the ability to coordinate care, it will be necessary for all of the health care providers in a SNF to share information among themselves and to fully understand the resident’s medical and psycho-social needs. But, before we can do this, there needs to be improved communication between the hospital and the SNF concerning details such as the patient’s progress in therapy, how long antibiotics should be continued, how underlying disease processes can affect the patient’s current status, the degree of support from family members, and how the SNF can help the individual achieve their rehabilitation goals.

Our electronic medical records (EMR) systems may also be a barrier to the sharing of information between hospitals and SNFs as well as between SNFs and home care agencies. Many of us currently encounter the inability to link our EMR to our pharmacy or other relevant providers, or we encounter physicians who are unable to use our EMR systems at all, creating duplication of efforts.

Although we expect that hand-off communication will occur between nurses from the hospital and the SNF as well as from the SNF to the emergency room, we have no expectation that the physician from the nursing home will receive hand-off communication from the hospitalist or the attending hospital physician. Thus, vital information about medications, treatments, consultant follow-up, and the patient’s underlying medical history may be missed if physician-to-physician handoff is not completed.

In light of the explosive electronic communication advancements of this era—where people tweet their most basic thoughts throughout the day, where people text each other from the next room rather than speaking in person, where email is considered an acceptable substitute for real-time conversation—we are still not communicating effectively when it comes to the pertinent details of individual residents’ needs.

If we hope to be successful in providing care, coordinating services, and improving quality, let’s start by rethinking how we share information between providers and within our facilities.

Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, has been practicing nursing for 33 years, specializing in the care of geriatric patients. She is an Assistant Professor at Philadelphia College of Osteopathic Medicine in the department of Interdisciplinary Health Services. Dr. Warner-Maron is the president of the Institute for Continuing Education and Research, providing educational programs for individuals seeking licensure in nursing home administration.