Rapid Recovery Center from Mainstreet Health is bringing a model of post-acute care to San Antonio that will set a new standard for how patients heal and rehabilitate after surgery or serious illness — and it starts with medical care that takes the services of a traditional skilled nursing facility to the next level.
Set to open in spring 2018 at 6035 Eckhert Road, Rapid Recovery Center’s approach to post-acute care features purpose-built design and hotel-like hospitality, but it is physician-led care and an embrace of technology that make the organization a perfect partner for hospitals, accountable care organizations, physician groups and managed care payers.
Mark Fritz, President, Mainstreet Health
“Rapid Recovery Center’s mission aligns closely with that of acute-care organizations because we want to deliver the right treatment to every patient, every time, and help them recover as quickly and safely as possible,” says Mark Fritz, President of Mainstreet Health for Arizona and Texas. “Our facility is purpose-built to admit higher-acuity patients than typical skilled nursing facilities. That wouldn’t be possible without near-daily physician coverage that will include internal medicine physicians and a variety of specialists.”
Physicians Lead the Way
Along with a group of outstanding attending physicians, RRC’s Medical Director, Iliana A. Grever, MD, will manage patients’ medical care on a daily basis with assistance from an onsite nurse practitioner. She will also address any changes in status that occur. Specialists representing pulmonology, cardiology, physical medicine and rehabilitation (PM&R), and pain management will be on hand up to six days a week to provide disease-specific care. PM&R physician Alasdair Goldstein, MD, Regional Director for Rehabilitation Services at Baptist Health System, will focus on helping patients overcome functional barriers to discharge.
“While Dr. Grever and RRC’s other outstanding attending physicians manage the medical side of things, I will lead the physical therapists in helping patients make functional gains and solve the issues that keep them from going home,” Dr. Goldstein says. “In spinal cord injury patients, for example, one such issue may be managing bowel and bladder function. If that’s not a problem, we may need to address how to navigate the bathroom with only one functioning arm. For total joint replacement patients, we will work on safety, balance and strength to reduce their risk of falls.”
Left to right: Alasdair Goldstein, MD; Michael Barker, MD; and Marc Pecha, MD
The Right Place for Pulmonary Patients
Providing piped-in hospital grade oxygen and having on-site care by pulmonologists will enable some patients to discharge from the hospital sooner.
“Most skilled nursing facilities cannot provide care for individuals who need high-flow oxygen because they use oxygen concentrators,” Dr. Grever says. “Rapid Recovery Center will have 33 rooms equipped with piped-in oxygen capabilities. That will allow us to admit more and increasingly complex pulmonary patients earlier and wean them off of supplemental oxygen at our facility.”
Dr. Goldstein will coordinate with pulmonary services to offer a pulmonary rehabilitation program. Patients with congestive heart failure, chronic obstructive pulmonary disease and other long-term, lung-related issues will learn to expend energy efficiently and navigate life with oxygen lines, which can be tripping hazards.
Ideal for Bundled Payments
Rapid Recovery Center is well positioned to provide efficient, cost-effective care to joint replacement patients and others involved in bundled payment programs.
“In a bundled payment plan, a hospital may be responsible for the cost of, say, a knee replacement patient’s care for 30, 60 or even 90 days after surgery,” Dr. Goldstein says. “The hospital and the surgeon want to ensure the patient recovers in a facility where he won’t get sick and bounce back to the hospital, and where length of stay is efficient and quality of care is high.
“Rapid Recovery Center is not a traditional skilled nursing unit, which is typically a wing of a nursing home that is focused on residential care,” Dr. Goldstein continues. “Rapid Recovery Center is going to admit only patients who need skilled services, so they will stake their success on patients’ functional improvements, as well as preventing complications and hospital readmissions.”
A hallmark of Rapid Recovery Center’s model is an individualized approach to length of stay that prioritizes functional readiness for discharge rather than brevity.
“An appropriate length of stay for a patient recovering from a stroke will be longer than a patient who’s had knee replacement, in most cases,” Fritz says. “To set the right length-of-stay expectations for patients, families and referring physicians, our staff will take into account the unique elements of each case.”
“Choosing the best post-acute care provider is critical to a patient’s recovery. At Remedy Partners, we’ve worked with more than 1,000 providers in bundled payment models and we are looking forward to exploring a collaboration with Rapid Recovery Center,” says Melanie Gittiban, Vice President of Partner Services at Remedy Partners. “We are encouraged by Mainstreet’s leadership, which is focused on providing a quality clinical experience for the patients they serve with a focus on community re-entry.”
With the help of technology, however, trends can emerge and inform future decisions about care. Rapid Recovery Center will use the domo analytics platform to predict the likelihood of hospital readmission, based on diagnoses and comorbidities, and adjust patients’ management plans to do everything possible to prevent bounce-back.
“Domo will also allow surgeons, primary care physicians and other referring clinicians, as well as our own case managers, to access dashboards with the customized information they need about their patients,” Fritz says. “With these dashboards, external clinicians will have complete insight as to what’s going on with their patients.”
The use of technology to enhance the safety, efficiency and efficacy of care will be a defining characteristic of Rapid Recovery Center. Our EHR will allow internal and external physicians to monitor patients’ lab results in real time and enter orders at a moment’s notice, ensuring changes in medication or care take effect promptly.
“When I go on rounds, I’ll be able to call up patient information on a tablet and hold each individual’s medical record in my hand at the bedside,” Dr. Grever says. “That will make it much easier for me to manage patients.”
The transitions from hospital to post-acute care and post-acute care to home are often fraught with gaps on the continuum of patient recovery, but they do not have to be. Rapid Recovery Center will take steps to ensure that those transitions do not throw patients off track.
When patients arrive at Rapid Recovery Center, they will face no lag time before they are able to continue or begin a course of medication, as the facility will have a medication dispensing system stocked with more than 400 of the most commonly ordered medications including schedule II medications. On discharge day, patients can choose to leave Rapid Recovery Center with a 30-day supply of their medications, eliminating a major reason for post-discharge hospital admissions — failure to obtain necessary prescriptions in a timely manner.
“Picking up a prescription at a drugstore can be a difficult task for some patients who leave a post-acute care facility,” Fritz says. “At Rapid Recovery Center, we will give patients the option to leave with a month’s supply of the drugs they need, so all they’ll have to worry about is going home and getting settled and continuing their recovery.”
Discharge planning will begin at admission. Many patients will need some degree of additional care, such as home health nursing or physical therapy, after leaving Rapid Recovery Center, and our staff will begin arranging those services right away.
“A select group of home health providers will have an office at Rapid Recovery Center where they can work with the RRC staff to arrange for in-home rehabilitation, nursing care, durable medical equipment and other services after discharge,” Dr. Grever says. “Rapid Recovery Center will follow up on patients at home for up to 90 days in an effort to prevent hospital readmissions.”
The Future Is Now
From an array of amenities to purposeful design and technology to clinical care excellence, Rapid Recovery Center will introduce San Antonio to the future of post-acute rehabilitation, one patient at a time.
“Hospital lengths of stay have decreased tremendously, and a lot of care that used to take place in hospitals now happens elsewhere,” Dr. Goldstein says. “Skilled nursing facilities, today and in the future, have to provide a much higher level of care than they did just a few years ago. Rapid Recovery Center is not your grandfather’s skilled nursing facility. RRC has made it a point to forge relationships with hospital physicians, case managers and C-Suite executives. Often, there’s a big divide between the physicians who treat patients in the hospital and those who see them in a skilled nursing facility. That won’t be the case at Rapid Recovery Center.”
The San Antonio facility will be the latest of four Rapid Recovery Centers in Arizona and Texas to begin welcoming patients, with eight more slated to open in 2018 and 2019. For more information about Rapid Recovery Center and a list of locations, visit rapidrecoverycenter.com.