Ben Kurland, CEO of Allaire
Most long-term care has been hurt by low occupancy and consumer anxiety during the pandemic, but one group has generally fared much better than the others: providers focused on intensive rehabilitation and transitional care.
This is largely because they were able to demonstrate their value to upstream vendors who need reliable point of sale for step-down patients.
The trend towards targeting clinically complex patients is nothing new, but observers say the continued pressures on payment incentives that unite payers and providers in terms of risk, as well as persistent specific needs related to COVID-19, have accelerated transformation.
“No question about it,” said Bob Kramer, co-founder and former CEO of the National Senior Housing and Care Investment Center. “Specialized clinical programs working in conjunction with health systems are seeing real recovery and demand of a kind that has not been before.”
Kramer, who founded Nexus Insights last year to help develop new pension models, calls this subsector “periacute” care and compares it to a protective moat around the castle that is acute care.
Shortly before COVID-19, Allina Health Services cared for a mix of rehab patients, medically complex conditions ranging from traumatic brain injury to heart failure and long-term care at four facilities in New Jersey and Pennsylvania. Amenities include private suites and gleaming rehab gyms. Respiratory therapists and wound care specialists conduct therapies with devices that are more common in hospitals.
Last year, Allaire’s focus on clinical staff and subacute recovery became a lifesaver – both for patients who would continue to fill beds for much of the past year and for the company itself. Allaire each had a facility in New Jersey earlier this year , New York and Vermont added. Pennsylvania health officials also tapped Allaire to run a facility that was overrun by COVID-19.
Like Allaire, Ignite Medical Resorts grew significantly in 2020. Much of this expansion was expected through new partnerships with LTC Properties and Sabra Health Care. However, CEO and co-founder Tim Fields has also signed an agreement with NHI to operate a new Milwaukee facility and acquired two Ascension properties in the Kansas City market. Ignite plans to lay the foundation stone in an eleventh location by the end of this year.
Fields said, managing the pandemic on a growth path required nimble leadership and the ability to reuse people and equipment frequently. He created dedicated COVID-19 units to strengthen relationships with key acute partners and took in an estimated 1,200 patients.
“We strategically realized that we had to flip the switch,” said Fields. “We get 98 to 99% of our business from hospitals. We have to have our pulse all the time. We saw this as an opportunity to be part of the solution. “
With a high nurse-to-patient ratio, in-house therapy, and medical equipment already in place, the company used technology to remotely monitor heart rate and oxygen saturation and safely deliver therapy to promote strength gains. In buildings where 90% of beds were typically filled with rehab patients at any given time, 75% of beds may have been filled with COVID-19 referrals. After June, the mix fluctuated but the census remained stable, Fields said.
Allaire also created COVID units, starting with one floor at its Morristown facility. Careful attention has been given to isolation precautions – including visitor restrictions from state and federal mandates – the use of private spaces and constant access to PPE.
“I personally called the hospitals several times a day,” said Ben Kurland, CEO of Allaire. “What do you need? How do we get it? What can we do? There is a high level of cooperation.”
The idea that these conversations took place with both upstream and downstream partners – and sometimes in group chats with colleagues in the same region – isn’t surprising given the pressures from managed care and incentive-based payment models.
“When you are a payer, you do everything you can to discourage a patient from hospitalization,” he said. “Whoever bears the dollar risk, you’ll definitely like it when you enter a new facility that has brand new equipment and increased staffing levels.”
Prove your worth
In Texas, Bridgemoor Transitional Care saw a “shocking” drop in occupancy of around 50% after the state suspended elections.
Like many other vendors, Bridgemoor worked with its real estate partner Invesque on short-term debt relief. Invesque executives recently confirmed on a earnings call that they did not receive any revenue from Bridgemoor in the fourth quarter of 2020.
However, in an interview earlier this month, Fritz took on a more optimistic tone, carried by an ongoing relationship with a hospital that asked its facilities to outsource some of its COVID-19 patients.
“One of the reasons was the relationship we had with them and the ability to take in more medically complex patients,” said Fritz. “The private rooms, that was a big factor.”
Bridgemoor had no internally acquired COVID-19 cases until an outbreak of four patients in February, a fact it could herald when hospitals were ready to send out surgical patients.
Bridgemoor has strengthened its relationships and is preparing to test special programs for heart failure and COPD starting this spring.
“Our industry is changing, and this will only be part of it,” said Fritz.
If necessary, be an asset
Of course, not all providers have the capital to switch to single beds or take revenue offline if occupancy stays at record lows. When the census mix relies on Medicare recommendations to balance a majority of Medicaid customers, a small bite on the apple can bring in the needed profits.
“If there is a particular need in your market, specialize in it,” said Kramer. “Find out what that dollar costs for that particular type of care? Build your reputation on it. Show your health systems, “You can trust us on this condition. And we’re really good at keeping people out of the hospital. ‘“
Fields believes that sharing Ignite’s COVID-19 success will increase confidence in programs dedicated to dialysis and pulmonary rehabilitation – potentially vital for long-distance COVID drivers with fibrosis.
And Kurland predicts that those who stood the test of time during the pandemic will be a well that providers will return to in the future.
“It makes us an asset to them when they have needs,” he said. “Today it was COVID, tomorrow it will be different.”