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Health Care Reform Brings Enhanced Opportunity for Post-Acute and Long-Term Care

Dale ThompsonPerspective from Dale Thompson Stratis Health Board chair

The long-term care segment of America’s health care delivery system is engaged in an ongoing effort to transform itself on many fronts. Nursing facilities are rapidly adding short-stay or post-acute care units focused on transitioning patients from an acute care stay to home. New specialized care settings focusing on dementia and end-of-life care are also emerging throughout the industry. Housing with services options continue to improve and are being more creative to meet the needs of consumers with higher expectations for living settings design and the care and services provided to them.


The Benedictine Health System’s (BHS) strategic initiative calls upon us to move in this direction as well. We are also focusing on a new vision for providing care at home, developed using an established care coordination model designed to deliver care and support across a broad spectrum of services aligned with integrated, at risk payment systems.
Although most media attention regarding national health care reform has focused on expanding coverage for the uninsured, recently passed legislation has a great deal of language that will enable new forms of service delivery and greater collaboration and integration of services across the entire health care continuum.

The Patient Protection and Affordable Care Act (PPACA) of 2010 provides insight into opportunities to create an enhanced use of post-acute settings. The alignment of these settings with acute care providers seems timely.
BHS has partnerships with several hospital systems to design post-acute settings to serve patients who require discharge to transitional or rehabilitative care facilities.


Some of the most interesting provisions of PPACA regarding the development of post-acute settings include:

  • National Pilot Program on Payment Bundling requires a national, voluntary pilot program to coordinate care for Medicare beneficiaries. Services will include acute care and post-acute services including skilled nursing, inpatient rehabilitation and home health care.
  • Value-based Purchasing requires a Medicare value-based purchasing implementation plan for Skilled Nursing Facilities be developed.
  • Hospital Readmissions Reduction Program will reduce payments to hospitals for preventable Medicare readmissions. A strengthened post-acute continuum of care aligned with hospital discharge needs could reduce the risk of negative payment consequences.
  • Medicare Share Savings Program looks to Accountable Care Organizations (ACOs) to take responsibility to reduce costs and improve quality. ACOs can include a broad definition of providers including post-acute, long-term care professionals, and providers.
  • Community-based Care Transitions Program provides funding to hospitals and community-based entities that furnish evidence-based transitional care services to Medicare beneficiaries at high risk of readmission.
  • Independence at Home Demonstration Program creates a new program for chronically ill Medicare beneficiaries that would test payment incentives and service delivery systems that utilize home-based primary care teams aimed at reducing expenditures and improving health outcomes.
  • Medicaid Bundled Payment Project establishes an eight-state demonstration project, with bundled services including acute care hospital and post-acute.

Across the broader long-term care continuum are numerous other provisions of the reform legislation that will impact care and service delivery.

As we enter a significantly new era of health delivery, long-term care providers likely have a great opportunity to enhance the quality and perceived value of their services, as well as work collaboratively with physicians and hospitals, to create the future.

Dale Thompson is chair of the Stratis Health Board of Directors. He is president and CEO of Benedictine Health System, one of the nation’s most extensive long-term care systems, providing acute and long-term care in nine states.