SVH Skilled Nursing Facility Task Force Update
September 18, 2018I want to keep everyone updated on the activities of the SVH Skilled Nursing Facility (SNF) Task Force. As you may have read, the Task Force is composed of several hospital leaders, physicians and staff, along with two community members and myself as Chair. We’ve held two meetings and also utilized the expertise of a consultant group which specializes in skilled nursing facility issues. Our key questions to address are to validate the profitability estimates and projections that have been presented; evaluate whether there are sustainable ways to increase the census, occupancy and profitability of the unit; and evaluate whether the SNF alternatives here in Sonoma Valley are sufficient for our community in terms of capacity and quality.
As some may be aware, eligibility for and reimbursement to the hospital for skilled nursing care is extremely complex. To be eligible for admission and for the hospital to be able to be reimbursed by insurers, patients must have a three-night minimum hospital stay. This can be challenging. Many surgical procedures used to have longer hospital stays, but these days many of them, particularly some orthopedic procedures, are now what are called 23-hour stays, so these patients generally are discharged to home, rather than to the SNF, within 24 hours.
The level of reimbursement is also variable and is based on the intensity of various therapies, which may be physical therapy, occupational therapy and speech therapy, as well as required nursing care. These are called RUGs, or Resource Utilization Groups, and are complicated to manage as there are multiple levels that require close monitoring and documentation. It’s important to note that the vast majority of hospitals have closed their skilled nursing facilities because of the low reimbursement, high resource utilization, and difficulty in managing. Most hospitals now rely on community-based SNF’s to care for their discharged patients.
As has been previously discussed, small hospitals across the country are experiencing significant financial difficulties because of their small size and continually declining reimbursements, so it’s very important that services that utilize many resources are thoroughly evaluated to ensure viability.
We have received and reviewed the consultants’ report, which validated many issues (e.g. that the size of our SNF makes it difficult to efficiently staff the unit), but also identified a few issues and possible opportunities we need to address and evaluate further. We are in the process of doing just that. The task force is working well and we’ll continue to update you as we have additional information and/or recommendations. Because a part of that evaluation will involve testing staffing alternatives and ways to increase revenue, I would not anticipate a decision until the end of this year at the earliest.
We have scheduled a meeting for September 27 at 5 pm in the Community Meeting Room (177 1st Street West) to share important information about the SNF, including financial, patient volume and reimbursement, as well as to hear public comment, and hope to see many of you there. If you are unable to attend the public meeting and have a comment to offer, please submit it in writing to the Health Care District’s Board Clerk at sfinn@sonomavalleyhospital.org. We look forward to receiving your comments and feedback as we move forward with this process.
Sincerely,
Jane,
Jane Hirsch
First Vice Chair, SVHCD Board of Directors
SNF Task Force Chair
E-Mail
