Bed leasing program helps hospitals discharge hard-to-place patients
Nurse practitioners placed in SNFs help cut readmissions
Executive Summary
UCLA Health’s program that pays a negotiated daily rate to skilled nursing facilities to hold beds for patients who otherwise would stay in an acute care bed saved a total of 2,516 acute care days from June 2014 to July 2015.
- UCLA Health pays a negotiated daily rate if the beds are occupied or not. The rate covers boarding, nursing care, medications, and physical therapy and occupational therapy
- Nurse practitioners are embedded in the participating nursing homes and provide care for UCLA Health’s patients every day, often treating problems that might cause a readmission.
- The program helps with emergency department throughput and frees up acute care beds for patients who need them.
By paying skilled nursing facilities a negotiated daily rate to hold beds for its hard-to-place patients, UCLA Health saved a total of 2,516 acute care days between June 2014 and July 2015 by placing patients in the leased beds.
“The program is paying for itself, even with all the costs of the bed lease. Without our arrangement with the skilled nursing facilities, we would be keeping these patients in the hospital longer,” says Marcia Colone, PhD, ACM, LCSW, system director for care coordination at UCLA Health, with headquarters in Los Angeles.
UCLA Health includes two acute care hospitals: Ronald Reagan UCLA Health, a 520-bed Level 1 trauma center located in Los Angeles, and Santa Monica UCLA Health with 266 beds. The system also includes Resnick Neuropsychiatric Hospital and Mattel Children’s Hospital.
The hospitals experience 45,000 emergency department visits and 25,000 admissions each year and consistently have an occupancy rate of 95% or higher.
“We are an academic medical center and many of our patients have very high acuity and complex conditions, along with psychosocial issues that create barriers to discharge. Many are homeless, have no insurance, or are underfunded. When these patients need to go to a skilled nursing facility, it is difficult to place them,” Colone says.
The goals for the program include reducing emergency department wait times, reducing length of stay for hard-to-place patients, and cutting readmissions and emergency room visits among patients discharged to skilled nursing facilities, she says.
UCLA Health also developed a strategic partnership with home health providers and formed the Enhanced Home Health Quality Council to share information on improving services to patients, Colone says. (For details, see related article in this issue.)
Patients who were placed in skilled nursing facilities through the bed reservation program had an average of 9.6% all-cause 30-day readmission rate from the second quarter of 2013 through the first quarter of 2014, she says. This compares with an average of 30.9% among other patients at UCLA Ronald Reagan and 24% at UCLA Santa Monica.
The program placed 91 patients through the bed reservation program in 2012 and 261 patients in 2014, a 60% increase.
The program started in 2011 at two skilled nursing facilities and five reserved beds. The health system has expanded to 25 leased beds at the two facilities. The daily rate includes boarding, nursing care, medications, and physical therapy and occupational therapy, Colone says.
“If nobody is in the bed, we pay the daily rate and they hold it for our use. If we place a paying patient in the bed, we avoid paying the daily rate for the time they are in the facility,” she says.
The arrangement does not mean that the skilled nursing facility will accept any patient referred to them. The patient has to meet the facility’s criteria, Colone says.
Case managers on the unit identify patients who are potential candidates for the bed reservation program on a daily basis and begin working on a discharge plan early in the stay, she says.
A key to the success of the program is two nurse practitioners, who are employees of the health system and work full-time at the facilities to care for the patients who are transferred from UCLA Health, Colone says.
The nurse practitioners see patients every day, write orders, and treat them for issues that might cause a readmission.
The physicians at the skilled nursing facility are not required to see the patients every day, Colone points out. “Because they see the patients infrequently, they don’t see small problems that can get worse and lead to a readmission. The nurse practitioners see patients every day and take steps to prevent readmissions,” she says.
By being able to place patients without funding in a skilled nursing facility, UCLA Health frees up a bed for patients who require an acute bed. The program also improves patient flow and throughput by reducing the time patients spend in the emergency department waiting for a bed, Colone says.
The program is an advantageous situation for the skilled nursing facilities, too, Colone adds.
“The skilled nursing facilities know that to become a partner with UCLA is very important in terms of marketing and branding. By affiliating with UCLA, the facilities improve their chance of getting more paying patients,” she says.
UCLA Health’s program that pays a negotiated daily rate to skilled nursing facilities to hold beds for patients who otherwise would stay in an acute care bed saved a total of 2,516 acute care days from June 2014 to July 2015.
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