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« Coming To Your Census: Step 7 of 8—Embrace Web-based solutions | Main | Coverage Roundup of New ACO Rule: What Does it All Mean for SNFs and Long-Term Care? »

03/31/2011

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Working for a large SNF provider this is a common question at with my employer. I actually think talking about LOS is the wrong conversation. I would propose that we should be talking about outcomes instead of time. Now before you say, duh, let me explain. Too many times we get stuck trying to sell short term rehab. Then the question becomes , "what is short term". We find ourselves suck into an ever spiraling down LOS as each provider tries to do more, faster in the misguided belief that by getting patients out faster we are making them happier. Instead our conversation should be, "we can get you back to this level of function and that is going to take as long as it takes". By shifting the focus of the conversation to a specific outcome we somewhat negate the time discussion and create a goal in the patient's mind that is not affixed to a specific date or LOS. It is the difference between sending someone home, who is well and sending them home well enough.

Paul, you make a great point. Often the recent conversation about targeting short-stay/rehab patients completely leaves out the question of, "What is appropriate care for the desired outcome?" (Even my post didn't address it.)

As pay-for-performance and ACO concepts come into practice, this consideration becomes more critical. A formula for LOS based on anything besides clinical outcomes could be folly. I would think a mix makes sense. It makes sense for SNFs to expand capacity for providing rehab services as demand (and reimbursement rates) grow. Having outcomes determine LOS shouldn't diminish the effectiveness of that strategy.

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