SNF Operators Bash Health Care’s Shift into the Home

The home health industry can sometimes feel like an echo chamber when it comes to the home being the safest and least expensive site of care.

Outside the industry, however, that belief is often open for debate — and even downright denied.

The most recent rejection of the U.S. health care system’s shift into the home came last week during a panel discussion at the Skilled Nursing News Summit in Chicago, an event attended by nearly 300 skilled nursing facility (SNF) owners, operators and stakeholders.


Panelists included Transitional Care Management CEO Brian Cloch, Aegis Therapies CEO Martha Schram and George Hager, CEO of Genesis HealthCare (NYSE: GEN).

“Going into a SNF is going to be a far better deal,” Cloch — whose Illinois-based company develops, owns and operates transitional care facilities — said during the event. “I think we as an industry need to continue to fight for that.”

The rallying cry against the shift into the home is not a new one, at least from the SNF side of post-acute care.


In fact, Hager touched on the relocation of SNF patients into the home health setting in March while speaking at the Barclays Global Healthcare Conference. At the time, the CEO argued that ongoing diversion efforts had hit a clear “inflection point.”

Hager doubled down on that stance at the Skilled Nursing News Summit.

“If you walk around any of our skilled centers, I would like you to point out which patient you think can go home [for] less expensively,” he said. “The break-even point is maybe two hours of nursing care [at home]. If you go past two hours of nursing care in the home setting, you’re already through the break-even point.”

Headquartered in Pennsylvania, Genesis HealthCare and its subsidiaries form one of the largest post-acute care providers in the country, totaling about 400 skilled nursing centers and senior living community in 29 states.

“I think that train on the long-term care side left the station a while ago,” Hager said, referring to the home health shift. “I don’t see that as a real risk or an issue.”

Even so, private-pay patients have mostly disappeared from the SNF space, he noted, attributing the decline to the rise in assisted living facilities and continuing care retirement communities (CCRCs), in addition to home and community-based service providers.

In part, SNFs should be seen as a preferred setting for keeping health care spending down because of their success keeping certain patients from going back to the hospital, according to Cloch.

A recent study published in JAMA Internal Medicine supports that claim.

After analyzing more than 17 million hospitalizations of Medicare beneficiaries, researchers found that readmission rates for patients discharged to home health agencies were roughly 5.6 percentage points higher than those who went to SNFs.

“Medicaid managed care firms who own risk, they’re going to look for the lowest-cost provider they can find,” Cloch said. “When they try to shift into the home, they’re going to realize that the people living at home are in and out of the hospital so much that it’s increasing their cost.”

Overall, the conversation shouldn’t be so much about SNFs versus home health, but rather which site of care is most appropriate for an individual at any given point in time, according to Schram.

Texas-based Aegis Therapies provides rehab and wellness services across 1,100 different sites across the U.S., doing so in a largely site-neutral fashion.

“There’s a tendency to be in a silo and say, ‘Those darn SNFs are so expensive,'” Schram said. “That’s one of the reasons why I was so interested and passionate about building a model that’s setting agnostic. … [Figuring out] what’s the right point of transition from a SNF to home health? What does that look like?”

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