July 14, 2019, Maggie Flynn, Skilled Nursing News - The Elderwood chain has been on an acquisition kick in the upstate New York region over the past year, with purchases ranging from assisted living to skilled nursing — and backing from a corporate parent that took a unique route into the SNF world.
Post Acute Partners co-founders and co-CEOs Warren Cole and Dr. Jeffrey Rubin found themselves attracted to Elderwood’s geographic concentration, reputation for quality, and multiple levels of care, all of which played into the company’s acquisition of Elderwood in 2013.
Those qualities frequently make SNFs and senior care tempting to potential buyers. But the New York City-based Post Acute Partners, founded in 2010, didn’t begin with a traditional SNF acquisition: a pediatric skilled nursing operator in Pennsylvania, now known as Pediatric Specialty Care, which has six locations in the Keystone State. Nearly a decade later, Post Acute Partners is building its seventh pediatric SNF, Cole told SNN.
“We were introduced to the opportunity really from a capital structure point of view, and we [had] surplus capital, so we utilized it to consolidate their debt,” he explained, adding that its previous owner had been a debtor. “But we were also interested, ultimately in trying to help them improve their operations.”
Pediatric skilled nursing care is provided to medically fragile children, ranging from newborns to young adults from 18 to 21 years of age; it’s a Medicaid product, Cole said, and few facilities provide pediatric skilled care. The existing players in the space tend to be single-asset or one-to-three building businesses, lacking scale, and that led Rubin and Cole to see an opportunity.
“The possibility of creating really a fully integrated, top-to-bottom division that focuses on medically fragile children we thought was very cool,” Cole told SNN. “We also felt that even though there are providers out there that are doing this, in many instances really well, there are not enough providers out there doing that. And so the patient population was in sore need of additional services and additional providers.”
This business line wasn’t on the radar of Post Acute Partners when it began, but the opportunity was too good to pass up, Cole said, and Pediatric Specialty Care has since spread across Pennsylvania — with plans to expand into New York.
Post Acute Partners purchased a site in Rochester, N.Y., near the Strong Memorial Hospital, intended for a dedicated pediatric inpatient building, Cole said, once the certificate of need is filed and the program developed.
“These children would likely be in inappropriate settings, whether that’s backed up in an acute care setting, because the hospital can’t find a discharge destination, or maybe in a foster home that really doesn’t have all the resources necessary to care for children with this level of complexities,” he said.
‘A post-acute one-stop shop’
It’s part of Post Acute Partners’ goal to be a “post-acute one-stop shop,” in Cole’s words. In addition to Pediatric Specialty Care and the Elderwood senior living and care company, it runs Elderwood Health Plan, a managed long-term care plan that services roughly 850 Medicaid beneficiaries in a handful of counties in upstate New York; the home care agency Elderwood Home Care; and Post Acute Consulting, which helps SNFs with compliance and reimbursement, including preparedness for the coming Patient-Driven Payment Model.
In addition, it has offerings that fall outside the traditional post-acute network: Elderwood Transportation and three institutional pharmacies under the Woodmark Pharmacy umbrella, which service three states and a roughly 50-50 mix of Elderwood beds and third-party beds, Cole said.
The goal is to touch every level of the post-acute continuum, and that plays into how Post Acute Partners assesses potential acquisitions.
The company recently acquired two assisted living facilities from senior housing giant Brookdale Senior Living (NYSE: BKD) in Williamsville, N.Y. The new facilities are within walking distance of Post Acute Partners’ existing 200-bed SNF and assisted living facility in the town, creating something of a virtual campus, Cole said — with the goal of broadening the levels of care provided to the community.
“When we look at an opportunity for acquisition, what we ask ourselves is: Does this acquisition enhance our geographic footprint, so that it’s not duplicative to another facility that we have, so that we’re able to extend the Elderwood brand into geographies that don’t yet benefit from it?” he said. “And/or, does the target or subject facility provide a level of care that we’re not adequately providing? Even if we do have facilities approximate to it?”
Change as the only constant
As the federal government overhauls Medicare to try to focus more on patient outcomes, lengths of stay decline, and patient acuity grows, SNFs have to be prepared to change, Cole noted. To that end, Post Acute Partners is working on a variety of initiatives to develop new service lines, which Cole argued is the way of the future for SNFs.
One area of “pressing need” is patients with psychiatric or behavioral health diagnoses, Rubin said, so one of those initiatives is creating a program for these patients while accounting for appropriate reimbursement.
“Our dialogue is with our referral sources, where they’re having challenges — specifically with poor outcomes and rehospitalization,” Rubin told SNN. “How do we come up with a solution to truly move the quality of care for those patients? And as an aside, it’s not just the referral sources, it’s also the payers. They, too, are looking at the metrics.”
By working with payers and serving as the “one-stop shop,” Post Acute Partners can offer efficiencies in terms of contracts, its CEOs noted. But it can also work with insurers to develop special programs, such as an oncology program at a facility in Hamburg, N.Y. that was developed with Independent Health Association (IHA) and Roswell Cancer Institute.
Another initiative involves avoiding emergency department (ED) admissions or patients getting stuck in observation beds, Rubin said, by working on programs for patients either in the community or in assisted living.
“Instead of them going to the ED for an easy visit, we divert them immediately to a SNF,” he said. “And we’re also working with our local EDs, where patients arrive at that ED and there’s an ability to redirect them to our SNFs. That is something that we’ve been doing, and only continues to grow.”