A new collaboration aims to add skilled nursing beds to a region with substantial hospital back-ups, while also meeting a growing demand for additional pediatric and dialysis services.
St. John’s, a 125-year-old skilled nursing and senior care organization, and the University of Rochester Medical Center announced their strategic agreement Wednesday. Together, they are aiming to address a series of “key challenges,” including regional hospitals that are often operating above licensed bed capacity because of a shortage of available long-term care beds.
Due to staffing concerns and a New York Medicaid rate that shorts the provider about $110 per day per patient, St. John’s Home currently has just about 300 of its 455 licensed beds online, St. John’s President and CEO Charlie Runyon told McKnight’s Long-Term Care News.
During contract talks with URMC about its physician coverage, the hospital system relayed its own concerns about major backlogs tied to a lack of skilled care beds. The two entities soon sat down to find solutions that could be a win for each.
“We are literally a stone’s throw from the University of Rochester Medical Center and Highland Hospital and they’re both part of the same system,” Runyon said, adding that the system is the senior care organization’s top referral partner.
“We’ve had a relationship with them for years,” he added. “I think that this is the wave of the future. This partnership could not have gone better because it’s a win-win. It literally is. The hospital is really encouraged by the fact that we are doing what we can to make access for them, and we’re really encouraged that they’re going to help us financially to get over the hump.”
The two nonprofits signed a broad membership agreement, which allows the system to provide financial support that supplements the nursing home’s Medicaid payments. Runyon said that could help cover more of the cost of caring for patients on high-cost medications, those needing bariatric support, those whose Medicaid coverage is pending or other scenarios yet to be determined.
“We’re literally open to whatever they need,” Runyon said, noting that the promise of more patients and a new revenue stream is already improving access. “Knowing this relationship and the opportunity to work with the hospital was coming, a couple months ago we increased our CNA rates pretty significantly. I think that led to the first quarter [staffing] change we’ve seen. … This has basically allowed us to be a little riskier with what we do on the staffing side.”
Meeting hospital needs
The three-year agreement calls for two new specific service lines: St. John’s Home will add both dialysis and pediatric care units.
For the dialysis unit, St. John’s agreed to hold 15 beds for long-term care patients leaving URMC hospitals who need dialysis. The hospital system will lease space from the nursing home, support construction of the unit and then staff and operate it. To add pediatric beds, the nursing home must seek a certificate of need approval, but it ultimately plans to convert eight skilled beds to pediatric beds. The nursing home will contract with the hospital system to bring in the LPNs, RNs and respiratory therapists needed for patients on ventilators.
Across the country, more operators and hospital partners are coming together to make bed arrangements, share staff or come up with other services that help streamline the efforts to move patients in post-acute settings more efficiently.
Steve Goldstein, president and CEO for Strong and Highland hospitals and senior vice president for URMC, said in a press release Wednesday that the agreement should relieve some stress on providers trying to meet the community demand for inpatient care.
He noted that the Finger Lakes region has fewer hospital beds per capita than any other part of New York State, while Runyon pointed out that there is no local skilled nursing provider offering in-center dialysis. A 12-chair unit will serve URMC patients, as well as outpatient community members.
“Extending our collaboration with St. John’s Home is one more way we are working to help patients receive high-quality treatment in the most appropriate care setting,” Goldstein said.
At the end of the three-year agreement, Runyon expects both sides will want to pursue additional opportunities to problem solve creatively. He sees hospitals’ need for nursing homes to offer more clinically complex capabilities as an opportunity for operators to improve their standing.
With the two URMC hospitals closest to St. John’s Home classifying 100 to 110 patients a day as needing an alternate level of care — meaning they’re ready to discharge but have nowhere to go — more intensive partnership and a new approach to care coordination seems almost inevitable.
“The hospitals really were in a dominant position for a long time,” Runyon said. “They were kind of the 800-pound gorilla in every town. This alternate level of care issue is really kind of moving them into taking a look at us as now a resource that can help them.”
