From The Tennessean, Middle Tennessee Business section —
Stephen Flatt takes the helm as CEO of National HealthCare Corp. on Jan. 1, amid what he calls a “hectic time” as NHC navigates two partnerships with Middle Tennessee health systems and a rising demand for memory care services.
Murfreesboro-based NHC and Maury Regional Health co-own a new skilled nursing facility in Columbia, while an agreement with Saint Thomas Health is a long-term strategic initiative to provide seamless care after hospital discharge to post-acute care for recovery and rehab. Although the partnerships differ in structure, they spotlight what Flatt, president of NHC for the past six years, expects to be a trend: companies working together in various structures to integrate services into a seamless continuum of care.
The outlook for what Flatt calls “institutional care,” including skilled nursing and assisted living, is a mixed bag, with regulation and overbuilding tamping the need for new facilities. Meanwhile, the NHC will break ground on a 60-bed dedicated memory care facility in Knoxville later in 2017.
“In assisted living, there is some demand, but I think we’re nearing a bubble nationally,” Flatt said. “In memory care, I think, the demand is going to be a steady increase. Memory care is just a pandemic right now in America.”
Talk about the relationships with the hospitals and what that means about how care is delivered.
The relationship we have with Maury Regional and the relationship we have with Saint Thomas Health really both have the same undergirding foundation, and that is the complete care of the patient from the hospital stay through any post-acute stay that they may need, whether it’s in skilled nursing or home health or another setting. That is becoming paramount and … a big reason Maury Regional wanted to make this move. I might add that, for the last two years, we have quarterly meetings with Maury Regional to discuss quality metrics, outcome data, whether that is length of stays in skilled nursing or readmission rates to the hospital.
We are meeting right now monthly with Saint Thomas going over that same kind of data in addition to other data. We are doing things like measuring the length of time it takes to transition a patient from one of their hospitals into one of our skilled nursing facilities or home health. We want a seamless transition of care. We want that to be as good for the patient as it possibly can be, along with achieving outcomes like (reducing) readmissions and length of stay and making sure we’re achieving what Saint Thomas calls the quadruple aim for the patient.
NHC and Saint Thomas Health are creating a new system. What’s the time frame to tie a lot of it together?
It doesn’t all happen with the flip of a switch, and we are meeting regularly with (Saint Thomas Health) measuring data that is happening right now, establishing baselines and moving toward the other metrics that we knew couldn’t be accomplished overnight and would take some time.
We’re bringing a lot of moving parts together. We’ve been meeting monthly, and some subgroups have been meeting more often than that. I think overall it is going very, very well, and feel like at the end of 2017, it’s going to be a very positive clinically integrated system of care that will greatly benefit our mutual benefits.
You’re all running your own businesses, yet some of it has to be complementary. How has your team adapted to that collaboration?
It does require time on the part of our key leaders as well as the key leaders of those two health systems to get together and actually share the data and analyze the data and create action plans to improve the processes and outcomes, but that’s just really part of the new paradigm of the new world of health care.
Even though there is a lot of talk about the Affordable Care Act being repealed – and it may well be, at least in part – the reality is this kind of seamless continuum of care and shared responsibility for patient outcomes across the acute side and post-acute side is not going away.
How does that impact the way we do business? It’s another demand on time and resources, but we feel like it’s the way health care is going to be conducted in the 21st century.
There are 2017 projects locally in Hermitage and Knoxville as well as Missouri and South Carolina. Where will NHC’s future growth be?
We’re going to do what I call “cautious, prudent growth.” We feel like these are markets where we have established a presence and we are a preferred provider for health systems in those areas, and these will be some prudent growth opportunities.
Looking out, what we’re doing with Saint Thomas and what we’re doing with Maury Regional, I think, is actually going to be a trend going forward.
We will be involved in more conversations with joint development and integrated systems of care with health systems in different parts of the country, not just Middle Tennessee. I think those, in varying forms, are going to be a kind of prototype for what the future is going to hold.
What is the demand for facilities, and what’s your priority?
It’s a mixed bag. Actually the number of long-term skilled nursing beds is on the decline in America and it has been for over a decade, and there are a variety of reasons for that. One is shorter lengths of stay for patients and more people being cared for in other settings.
However, there is great demand for post-acute care – the ones we’re building are focusing in on being able to provide the physical, occupational, speech therapy, respiratory therapy for patients who come out of the hospital to help them rehab and get back home.
There has been a steady increase in the need for assisted living. In fact, assisted living has more than quadrupled in the last 20 years. Because it’s not as regulated as skilled nursing … you can overbuild in assisted living. That happened in the late ’90s and that’s happening right now so you have to be very careful about where you project new projects because there can be saturation.
The biggest demand for what I would call “institutional senior care” is going to be in the memory care area. That is going to be a particular focus of our growth going forward. Every assisted living that we build right now has, as a part of it, a designated secure memory care area.
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Reach Holly Fletcher at 615-259-8287 and on Twitter @hollyfletcher.