Post-Acute Providers Predict Probable Insolvencies Under Value-Based Care Without Basic IT, Data Sharing and Care Coordination, Black Book Annual Survey

100% of post-acute executives surveyed argue that EHRs and interoperability with acute care providers and physicians would radically improve their ability to thrive under VBC.

​​​​Black Book™ surveyed 1,640 providers of long-term and post-acute care (nursing homes, hospitals, short-term rehabilitation facilities, home health services, durable medical equipment/DME distributors, skilled nursing  and sub-acute facilities, and hospices) to help stakeholders of the provider industry identify strategic responses to address the higher growth/demand for post-acute services in the challenging environment of lower fee-for-service reimbursements and impending valued-based payment models from all payers: government and commercial.

Nearly 90 percent of skilled nursing and sub-acute facilities forecast there will be no shift in the portion of their payments shifting to value-based care in 2020 due to lack of IT capabilities and preparation.

Black Book’s annual post-acute IT user survey determines if there are more efficient ways to improve post-acute patient care while keeping providers accountable for improving quality and reducing costs through effective use of health care information technology. Specifically, the survey reported on health information exchanges (public and private), quality reporting, health analytics, workflow and care coordination, and patient engagement software/systems. Key findings include:

Electronic Health Record Adoption

Inpatient post-acute providers, overall, responded that 21 percent have some technological capabilities of EHRs operational in Q4 2019, as compared to 15 percent in 2016. Corporate chains and large nonprofit systems report the highest adoption rates among network post-acute care facilities nearing 40 percent as compared to 27 percent in 2016. The slow adoption rate and fragmented health IT environments are attributed to the different levels of technology investment and conflicting cultural priorities that prevent all providers from working together in a data-driven harmony, the study reveals 84 percent of post-acute administrators report having no budgeted funds for technology acquisitions or improvements in 2019.

“All healthcare organizations must find better ways to manage the patient transition into post-acute processes and keep hospital readmissions in check, and that may fall completely on hospital systems at risk in 2020,” said Doug Brown, Managing Partner of Black Book Research. “That answer will require the expansion of technology capabilities to connect physician practices, home health agencies, hospices, outpatient settings, skilled nursing facilities, rehabilitation centers, DME firms, and hospitals.”

49 percent of all post-acute providers surveyed assess the state of their staff’s health information technology proficiency as extremely poor or non-existent.


Long-term care administrators report 86 percent of their facilities are not exchanging health information electronically with referring hospitals, physicians, or home health providers (indicating no improvements in data sharing as compared to the 2017 survey). The far majority (96 percent) of those sharing some records with acute care providers are networked in closed silo health systems EHRs with the long-term care centers. “The enormous disconnect between the post-acute world and the rest of the continuum is not correcting as hoped,” said Brown. “Finding ways to improve communications between disparate acute care EHRs and post-acute technology is a pressing problem for detached providers.”


Value-based care requires data aggregation, provider communications and analytics. The Black Book study highlights that effective post-acute management requires a multidimensional approach that incorporates connectivity between providers, data analytics and clearly defined care coordination responsibilities. The benefits include reducing readmissions and allowing providers to interactively manage length of stays in sub-acute settings and monitor discharge.

Only 4 percent of inpatient long-term care providers reported having the capabilities of data-driven analytics to lower cost of care, reduce unnecessary hospital readmissions and ensure facilities receive proper reimbursement for the care provided to the patient. It is going to take a willingness to adapt and commit to using technology to confront the challenges ahead, but post-acute organizations admit they are not prepared. “Most long-term care organizations are still stuck in a volume-based mindset,” said Brown. “Integrating evidence-based practices through clinical operations can control rising costs, reduce duplication and other inefficiencies, and position the business to be a successful player in the reforming post-acute continuum.”

Care Coordination

Black Book predicted in 2014 that extensive and meaningful interoperability between healthcare providers was at least a decade away. “Long-term care facilities are still excluded from operating in a deeply connected care continuum due to limited resources and communication channels,” said Brown. In Q4 2019, 91 percent of care managers surveyed acknowledge that hospitals send their most complex patients with the highest morbidity to skilled nursing facilities with virtually no communication channels between the SNF and the acute provider.

“The lack of communication is an extremely expensive problem, especially as hospitals become financially responsible for long-term outcomes and preventable patient readmissions,” said Brown. Black Book predicts remote monitoring and video visits will be the temporary solution to allowing hospitals to track patients after discharge until the post-acute care facilities find ways to afford technology with connectivity.

“It’s clear that the lines between payer and provider are blurring and the expectation is that post-acute healthcare organizations must exist in a world of multiple payment scenarios,” said Brown. The study’s polling shows that 80 percent of long-term care organizations are struggling to account for care, receive proper reimbursement, manage eligibility, proving medical necessity and institute strong reimbursement, all of which are mandates as the financial environment evolves and reforms.

Other Key Findings

14 percent of Skilled Nursing Facilities and residential long-term care centers report daily use of an electronic health record.

72 percent of post-acute organizations report not having the internal human resources or capital to implement an IT strategy and successfully implement solutions in 2019.

77 percent of executives will attempt non-technological collaborations with VBC partnerships in 2020. 8 percent are hopeful to utilize currently available health information exchanges (HIEs) and accountable care organization (ACO) resources as VBC support.

10 percent of post-acute organizations plan to assess some form of updated workflow and/or data analysis tools in the coming calendar year.

Only 4 percent are evaluating or implementing patient engagement solutions in 2020.

About Black Book

Black Book™, its founders, management and staff do not own or hold any financial interest in any of the vendors covered and encompassed in the surveys it conducts. Black Book reports the results of the collected satisfaction and client experience rankings in publication and to media prior to vendor notification of rating results and does not solicit vendor participation fees, review fees, inclusion or briefing charges, and/or vendor collaboration as Black Book polls vendors’ clients.

Since 2004, Black Book™ has polled the vendor satisfaction across over 30 industries in the software and services sectors around the globe. Black Book’s mission is to improve healthcare delivery by expanding the stakeholder’s voice from the front-line employee, IT and financial managers, clinical and nursing staff through the C-Suite and Board, as well as healthcare consumers.

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Source: Black Book Research