Skilled nursing facilities play a vital throughput role in our nation’s healthcare system, but that role is increasingly tested by their ability to support a rapidly growing population of dialysis patients. Only a small number of SNFs offer dialysis on site, a shortcoming that creates length-of-stay concerns for hospitals and a logistical challenge for operators. 

An estimated 85,000-plus dialysis patients are admitted to SNFs annually, a number that is projected to grow by 6% annually. Current dialysis solutions, which include outsourcing or transporting these patients out to clinics, can leave a SNF with limited control of the care continuum, present a heavy logistical burden for staff and patients, and result in poor patient experience. With recent advances in hemodialysis technology, however, it’s now easier for SNFs to create a wholly owned dialysis program on site whereby the patient care continuum, reimbursement, and quality are all controlled by the SNF network.  

Better care is possible

In off-site dialysis models, when a patient with end-stage renal disease is discharged to a SNF, staff must immediately coordinate with a local dialysis clinic for that patient’s treatments. After arrangements are made, challenges often arise related to transportation delays, care issues during transport, weather delays, and missed treatment time.  

After treatment, patients often return from the clinic feeling groggy and fatigued leading to a decrease or inability to participate in scheduled therapy sessions. In some instances, rehab directly conflicts with dialysis, disrupting care and increasing the risk of hospital readmission.

In-house service providers also create issues

To date, the most widely accepted alternative to this arrangement has been contracting the service to a third party to perform hemodialysis on site at the SNF. This enables a SNF to accept more dialysis patients, but still has significant drawbacks related to cost and control of how and when dialysis is performed. 

The SNF typically bears the cost of infrastructure, such as building out a dialysis den and water room and may be obligated to provide additional staff to serve the provider while the service provider retains control of treatment staffing and scheduling. In this model, the third-party service provider collects the Medicare B reimbursement for dialysis and may also charge the SNF a sitting fee for every treatment. 

In a wholly owned SNF program within its existing walls, operators receive the entire reimbursement for treatments performed at their facility and control all aspects of treatment administration while simplifying logistics. Now that dialysis technology is more streamlined, a wholly owned program allows SNF operators to more easily realize:

  1. Census optimization. On site dialysis care enables a SNF to accept more kidney patients and eliminate caps.  
  2. New revenue stream. Providing dialysis care ensures the SNF’s dialysis entity secures Medicare B reimbursement for the service.  
  3. Reduced cost and risk. In-house dialysis eliminates expensive and potentially dangerous transportation.
  4. Easier scheduling. Eliminating transportation time makes it easier to schedule rehab and dialysis without conflicts. 
  5. Better continuity. Patients benefit tangibly from the continuity of care that a SNF-owned dialysis service offers. 
  6. Fewer readmissions. Better, more integrated patient care means fewer returns to acute care and stronger relationships with acute care facilities. 

Technology drives innovation

New simplicity and usability of hemodialysis technology allow the wholly owned approach, a strategy already being widely adopted across the acute and post-acute space, to become a reality for all SNF operators. These devices are easier to learn and more intuitive to operate, minimizing training requirements, while allowing remote monitoring, EMR integration, and elimination of costly infrastructure.  Moreover, by providing high-quality in-house dialysis, the SNF becomes a preferred referral destination for hospitals discharging kidney patients.

With thousands of kidney patients diagnosed every day, a wholly owned SNF dialysis program offers the potential for significant bottom line impact, increased operational control and a better, more consistent, higher quality experience for patients.

Michael Aragon, MD, is chief medical officer at Outset Medical, a medical technology company pioneering a first-of-its-kind technology to reduce the cost and complexity of dialysis. Aragon is board-certified in internal medicine and nephrology, receiving his training at the University of Texas Health Sciences Center in Houston.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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