How to Narrow Your Post-Acute Care Network – And Why It’s So Important

by Mary Kay Thalken, RN, MBA on Nov 13, 2019

doctors gathered around an ipadIn 2019, Leavitt Partners released a White Paper with a title that should be eye-opening to any caregiver:

No Evidence That ACO-Affiliated Hospitals Are Narrowing Their PAC Networks

That’s not good, guys!

The whole point of the narrow post-acute care (PAC) network is to identify, based on data, post-acute facilities that provide the best care possible for patients. But it’s become clear that identifying these organizations and actually narrowing the network is trickier than it initially seems, even for the most committed Accountable Care Organizations (ACOs).

One difficulty? Patients and their families tend to use location as their primary deciding factor rather than quality. And caregivers tend to follow their lead, subtly (or, oftentimes, not so subtly) directing patients to the facility that history and that individual’s zip code tells them they’ll be more likely to choose.

This is a bad habit to fall into, and hospitals and ACOs need to establish policies designed to combat lackadaisical discharge practices. Not only is it in a patient’s best interest to gain access to care quality data metrics, but doing so ensures you’ll be on the right side of the IMPACT Act and Medicare’s Conditions of Participation, which require the patient to be provided with a comparison of post-acute facilities and documentation of that individual’s ultimate choice. If they still opt to rely on the PAC that’s closest to their family, that’s okay, but at least you will have done your due diligence.

With all this as background, it begs the question: how exactly should you go about narrowing your post-acute network?

Here’s what we’ve found works well:


Getting Real About Readmission Rates


Readmission should be the first step in any facility’s efforts to narrow their PAC networks. If facilities repeatedly send patients back to you for follow-up care, when those patients by all measures should have been well on the path to recovery, these are your initial targets for exclusion.

Of course, in order to narrow based on readmission rates, you first have to track this information, something you really should already be doing if you’re a member of an ACO and you want to receive the maximum reimbursement. If you’re not an ACO member or you’re for some reason not tracking readmissions, please start doing so. Tracking readmission will enable you to determine what post-acute care organizations are deficient in their care patterns, and it could even help you identify an error in your own internal processes that’s making readmission more likely (i.e. patients being discharged too soon for a given condition).

Once you have a means of measuring readmissions, start by looking at the 30-day window to find out which PAC facilities have a heightened return rate. Then, once that’s been established, move on to the 60-day and then the 90-day window.

But don’t stop there. Just because reimbursement only goes out so far, you actually ought to dive even deeper into the data, to 120 days and beyond. What you’re looking for is patterns of readmission that can be used to narrow your post-acute network to only those facilities with a proven track record of providing appropriate care and keeping patients from being readmitted to your facility.


Response Rates


Another metric that’s almost as important as readmission rates is response rates.

How, you may ask, can we rank this right behind readmission when response rates don’t actually speak to the clinical capabilities of the facility? The answer is because of the clinical impact a lack of consistent response can have on you and what it means for your patients’ long-term health.

Imagine a PAC facility with expert staff, a sterling track record and high patient satisfaction scores. Sounds like a dream, right? But, unfortunately, this facility only responds to your discharge queries 50% of the time. And of that 50%, they can only take a patient in 10% of their responses.

Whether that’s due to the facility’s overwhelming popularity or just a failure in their communication procedures, the fact remains that you’re only discharging a patient here in 5% of all attempted cases.

What does that mean for you? Additional acute days where the threat of infection and other hospital-developed issues persists, a bed tied up for longer than it should, a dissatisfied patient, and clinical staff who aren’t being utilized to their utmost potential.

In order to have a truly successful PAC network, the facilities within that network have to be reliable. You need to be confident that, when you submit a referral request to a PAC facility, you’re going to hear back and, in a majority of cases, their answer will be a definitive ‘Yes.’ What’s more, they need to be able to admit that patient within an acceptable timeframe so you can do what’s best for the patient while freeing your bed up for someone else.


All the Rest


Readmission and response are the big two. They’re not the end of the conversation, but they will get you pretty far down the line.

Then there are all the other factors that play into the narrowing of your network. And these will depend on the unique needs of your facility.

Some organizations, even after accounting for readmission and response rates, already have a sufficiently shrunk list to work from. Others still have an unwieldy scroll of dozens and dozens of PACs. At these times, you need to determine what’s important for your facility.

Is it EHR interoperability? This is a big one for plenty of organizations. To ensure an optimum patient experience and reduce the possibility of errors, you may look to facilities that share a similar EHR as you or, at the very least, have a compatible system. It may not be as clear-cut as Epic to Epic and Cerner to Cerner, but you should have a list of interoperable systems and, if the facility of choice matches, that’s a good sign. If, however, a given facility still relies on a fax machine or doesn’t have an EHR at all, these may potentially be excluded from consideration in your network, especially if their readmission and response rates are poor.

Perhaps it’s CMS quality ratings, or capabilities of care? Some ACOS and hospitals want to know their patients can take advantage of a litany of services, including those that aim to help the individual acquire access to things like transportation or affect the social determinants of health. Others may only be concerned that their patients will get access specifically to their unique clinical care component and leave it at that.

Still other hospitals prefer to narrow their networks based on the degree to which case managers and other staff members manage patient care. Some PAC facilities are very hands-on when it comes to scheduling appointments, contacting patients and family members, following up with prescriptions, etc., while others are very hands-off. This is yet another metric to use when determining how to further narrow your PAC network.




Readmission rates and response rates will get you pretty far down the tracks, and how you narrow from there will depend on your preferences.

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Meet the Author

Thalken brings more than 30 years of experience in health-care leadership to our company. Prior to joining the company, she served as Enterprise Vice President for Care Logistics in Atlanta, Ga. She has held executive leadership positions at hospitals in Nebraska and Iowa, including the position of System Quality Executive for Alegent Health. Thalken has presented on the topics of improving quality, patient flow and throughput at various industry conferences and webinars. Thalken holds an MBA from the University of Nebraska at Omaha. She is a member of the American College of Healthcare Executives, American Organization of Nurse Executives and American Case Management Association.