Reforms under the Affordable Care Act are prompting hospitals, skilled nursing facilities and other providers across the country to look for ways to cut costs.
Rick Grindrod figured he could help, given his experience as the former CEO of Erickson Retirement Communities, the Baltimore-based firm now known as Erickson Living that owns Charlestown in Catonsville and 17 other continuous-care retirement communities.
In 2013, the Severna Park resident launched his own consulting firm, National Post-Acute Healthcare, to work with skilled nursing facilities and hospitals as they set up contracts to participate in a new Medicare reimbursement program called bundled payment for care improvement.
Launched as a reform under the Affordable Care Act, the Medicare reimbursement option sets target prices for the care and, if the care ends up costing less, the providers can keep the difference. If it's more expensive, they must foot the bill.
National Post-Acute Healthcare is working with about 200 skilled nursing facilities applying to participate in the program in states from New England to the Carolinas. They hope to launch this spring.
What does the bundled payment program mean for patient care?
The real dollar savings is to prevent [a] patient from experiencing a decline in health care that then would require them to go back to the hospital. So the hospitals are [motivated] to figure out how to establish strategic relationships, integrated care protocols that reduce the return-to-hospital rate.
It's a financial relationship, it's a communication relationship, it's a care protocol relationship. Up until the Affordable Care Act and the new Medicare waiver, there really were very limited incentives on outcomes and on financials to implement those kind of integration programs.
When you say "integrated health care program," can you talk a little bit about what that means?
When I talk about an integrated health care delivery model, what I'm talking about is clear pathways, clear clinical protocols about how information will be communicated from the physician to the hospital to the post-acute facilities or post-acute care setting that are predetermined and well implemented so that patient information doesn't fall through the cracks. … Really, a lot of the waste and errors that you find in the health care system happen in those transitions of care and hand-offs between levels of care.
From a patient perspective, what do the bundled payment programs mean?
A patient who hasn't experienced the deficits of being transitioned from one level of care to another and not having adequate communication probably wouldn't notice any change. But a patient who was discharged form the hospital and admitted to a skilled nursing facility would receive the services and input of a care navigator … to help with those transitions. She has contacts and communication protocols with the hospitals, so she is finding out not just what happened on the last day of discharge. She's getting the full picture.
What kind of challenges do you face?
The biggest challenge that my company faces, as well the participants in any of these programs, is that the rules aren't set and so [Centers for Medicare and Medicaid Services] is reacting to the experience that providers are having in the program. They're updating and changing and innovating, and so it's very much like fixing a moving vehicle.
That's a challenge. I personally believe that's a good challenge. This is where my analogy of the car falls apart … but I think that rapid iterations of change in innovation works much better.
What else do you do besides coaching for skilled nursing facilities?
I do a program with our church where I go to Nicaragua twice a year and help an organization down there called the NEO Fund with business development and micro-loans. We're working on providing micro-loans for women who have just moved out of literally living inside the Managua trash dump and their livelihood up until now was picking trash and selling to a recycler.
What I'm doing is I'm working with the borrowers to [figure out] how can they improve their business, what can they do about keeping better financial records, those kinds of things.
Title: CEO of National Post Acute Healthcare
Born: Parkersburg, West Virginia
Residence: Severna Park
Education: B.A., Bucknell University; MBA, Loyola College in Maryland (now Loyola University Maryland)
Family: Married with three children, ages 24, 23 and 19
Interests: Board member of Maryland Shock Trauma Center, St. Agnes Hospital and Indian Creek School; boating; church activities