FEATURE


alternatives and ASCs and CCs are able to meet that need.”


The CC model should be spread-


ing to other states that are looking for positive solutions to ever-escalating health-care costs, Craig suggests, but they are usually stifled by competing entities fearful of losing revenue. “We need to move beyond ‘turf wars’ and the antiquated models of the past to sustain our quality health-care options in the future,” she says. “This change will only occur if progressive leaders and regulators help spread this positive solution forward state by state.”


Skilled Nursing Facilities To educate himself about post-acute services in his area, Andy Whitener, president of Post-Acute Care Expertise in Gainesville, Georgia, started con- tacting skilled nursing facilities (SNF). “Several of the SNFs I met with are open to providing the post-acute ser- vices an ASC needs,” he says. “ASCs performing more complex procedures could benefit from accessing the exist- ing services of an SNF. They are pre- pared to monitor vitals, address pain and feed patients and do so at a sat- isfactory payment rate. They may be willing to take on the added responsi- bilities and meet the standards of care our ASCs and patients expect. The need for such coordination is increas- ing as the types of cases performed in an ASC become more complex.” SNFs handle patients that need


recovery time or rehabilitation ser- vices after surgery, but not critically ill patients, Ashby says. “Within the last five years, four or five SNFs have started in Colorado. These new facil- ities look nice, like hotels or resorts rather than a medical facility, and are primarily Medicare driven. They are mostly developed and owned by physi- cians and are staffed with nurses, ther- apists, physical therapists, CNAs and other aides. They have their own bill- ing structure and each state has its own licensure structure for SNFs.”


SNFs are regulated by state and


federal regulations/guidelines, Whit- ener says. “They can request spe- cial accreditation, primarily by The Joint Commission and/or the Com- mission on Accreditation of Rehabili- tation Facilities (CARF), usually for specialty programs. They report out- comes to the federal government on the ‘Nursing Home Compare’ site.” The challenge with SNFs is the transportation piece,


Ashby says.


“You’d need an ambulance or personal vehicle to get to them.” To work with an SNF, an ASC


would need to develop an agreement with the nursing home and address non-emergent transportation and protocols for how to deal with poten- tial issues, Whitener says. “Insurance


companies will need to be included in the discussions, whether they were to pay the SNF for services or if the ASC were to make the payment. Liability will need to be addressed. Documents will have to be created to inform the patient of the possibil- ity of an overnight stay in a nearby facility, and processes and docu- ments must be created to provide for a smooth clinical transition.” Like CCs, SNFs would save the health care system money. “Nego- tiated rates that have been reported to me to care for a 23-hour stay post an ASC surgery have been between $800 and $1,500,” he says. “The SNF can negotiate these directly with the payer. I am not sure what a single night stay in a hospital would


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