Subacute company makes first move

Physician involvement is powerful pawn

Providing comprehensive medical and post-surgical care in a subacute care setting with in-house physicians is one way to stay ahead in today’s changing reimbursement landscape.

For Guardian Health Group, a Corte Madera, CA-based subacute and skilled nursing provider, that scenario is becoming reality. And subacute providers that align with other providers now to offer cross-continuum care will fare better under changes to the Medicare reimbursement system. Those changes could come as early as next year, experts say.

Rather than aligning with acute hospitals, Guardian sought a relationship with a physi-cian group. The decision to formally align with a physician group was to offer payers an alternative to costly acute care, says Robert Peirce, president and chief executive officer of Guardian. The agreement was reached last October and is being implemented on a facility-by-facility basis.

Providing the best care at the lowest cost will become increasingly important under any changes to the Medicare reimbursement system, notes Peirce. "The market forces will seek out the lowest cost bed and pay for care wherever that can be done, and with this program, acute care providers can’t come near our rates," he adds.

Guardian’s agreement allows it to offer physician services in its freestanding facilities through the 29 physicians in the Fullerton Medical Group. "We have been managing the subacute unit at [the San Francisco-based] California Pacific Medical Center for five years and approached the primary physician group to see if it would be interested in staffing our freestanding centers," adds Peirce.

Goal is to provide care in all facilities

The agreement is mutually exclusive and will only be implemented in Guardian facilities in California. Participation is at the discretion of the patient’s attending physician. Guardian’s patients are equally split between managed care and Medicare enrollees, estimates Peirce.

Guardian currently has three freestanding facilities offering 24-hour physician care. The goal, however, is to provide physician care in all 15 freestanding facilities. "We’re in no rush, and it won’t happen overnight," says Peirce.

Physicians are placed in facilities depending on patient caseloads, says Peirce. First, physicians consult with facility staff on a part-time basis and increase hours when patient volume increases.

"We’ve already had to increase the number of hours at one facility," he notes.

Facilities with physicians on staff are able to accept "any patient a hospital would accept," says Peirce. With on-site physician availability, Guardian can receive patients immediately following surgery. Other services include primary and preventive care services.

"We modeled the program on an organ transplant program used by one of the founders of the Fullerton group. The program emphasizes moving the patient quickly out of the acute care bed. His program boasts one of the lowest lengths of stay and costs for transplant programs in the country," Peirce says.

Participation is optional

Medical directors at some of Guardian’s facilities felt threatened at first, Peirce admits. Patient referral is strictly optional, however, and no physician is required to turn over their patient’s care to the staff physician.

An advantage of the program is the physician-to-physician communication, says Peirce. Physicians feel comfortable transferring care to the staff physician for a Medicare stay because "they like talking to one of their own during that stay, which usually lasts between 14 and 24 days," he notes.

The agreement also appeals to staff in Guardian facilities. Nursing staff have immediate access to physicians for patients needing additional care following surgery, says Peirce.

Guardian plans to expand its cross-continuum services by aligning with a home health agency later this year. "We have a capitated program in place with one agency, and no firm decisions have been made, but it’s definitely being talked about," Peirce adds.