This article was written by on June 16, 2019 but is still full of valuable information for us all.

Review the full article and images on the Skilled Nursing News website:

For the second time in less than a month, a national provider of dialysis services has teamed up with a major skilled nursing operator looking to expand its specialty capabilities — with an eye toward rolling out the program in a significant chunk of its buildings.

Signature HealthCARE, which has 115 skilled nursing facilities spread out over a 10-state footprint, has moved to add home hemodialysis services to select locations through a partnership with Dialyze Direct.

The two companies have executed a letter of intent, with pilots initiated in two Signature locations: Signature HealthCARE Center of Waterford in Hialeah Gardens, Fla., and Chautauqua Rehab & Nursing Center in DeFuniak Springs, Fla.

Dialyze Direct, which is based in Neptune Township, N.J., provides home hemodialysis on-site in SNFs, including equipment, training, and caregivers. The company recently announced an agreement to provide services in a handful of facilities at HCR ManorCare, part of the Toledo, Ohio-based health system ProMedica.

The Louisville, Ky.-based Signature is planning to add Dialyze Direct’s services to more of its facilities, though it’s not yet clear how many Signature locations will eventually add this service, Signature chief strategy officer George Burkley told Skilled Nursing News.

Still, the company has identified approximately 10 facilities as a first cohort of candidates for Dialyze Direct services, in addition to the two in the Sunshine State that are in pilots now, Burkley said.

“We’re stepping into this carefully,” he said. “[But] we do think there’ll be quite a good percentage of our facilities, whether that’s 10%, 20%, 30%, 40% — we’ll see with time, and how the marketplace in the communities receive our efforts to provide this service … but we think it’s quite a number of our facilities.”

Signature’s moves track with ManorCare’s strategy of proceeding slowly with a dialysis program. As with Signature, the nationwide SNF operator has two facilities where Dialyze Direct is offering services; however, ManorCare management plans to expand into just two additional facilities while assessing other markets where dialysis might be the right fit.

“Obviously, there are markets where it makes sense, and there are markets where there’s not as much of a need,” ManorCare assistant vice president Eric O’Neill told SNN at the time.

The dialysis push at major operators comes as the skilled nursing industry prepares for the coming of the Patient-Driven Payment Model (PDPM), which has led SNFs to take a closer look at the medically complex patients they serve. Some SNFs have seen an opportunity in dialysis as the Medicare overhaul draws nearer; a new SNF development project from Ignite Medical Resorts and Villa Healthcare, for example, will feature a dialysis unit in addition to other specialty programs.

Signature, for its part, is plotting growth in markets where the dialysis provider intends to expand over the course of the next few months, Dialyze Direct COO Josh Rothenberg told SNN: Florida, Ohio, and Indiana, with a second cohort consisting of facilities in Tennessee, Maryland, and Kentucky.

“The idea is to grow within [Signature’s] markets, where they are, and have the ability to make sure that this particular building is where the need is, and to growth throughout the system,” Rothenberg said. “We’re not starting Day 1, [with] 100 locations, but we’re going throughout the markets that they have, starting with three, and rapidly expanding into a few other markets where we ourselves are expanding as well.”

About 10% of the average SNF’s census requires dialysis services at any given time, and hospitals discharge about 90,000 patients who need dialysis to SNFs each year, he said. Many SNFs have shied away from taking such patients, he argued, in large part because of transportation challenges; if a SNF patient has something go wrong when they’re offsite for dialysis treatment, he or she will likely end up back in the hospital.

That could lead to readmission penalties for SNFs, which hit the majority of providers in the country last year for failure to meet rehospitalization benchmarks under the Value-Based Purchasing (VBP) program. And bad readmission rates could end up hurting a SNF’s relationship with acute care providers, Rothenberg noted. As a result, providing five-day dialysis services — which can see residents recover within 30 to 45 minutes — has value for SNFs.

For Burkley and Signature, that value takes the form of both operational benefits and resident satisfaction.

“To able to say, ‘This is going to be a two to three hour portion of what will be an active day for you’ … at the end of the day, we think it provides a lot of strategic value to the organization, but the core and the drive of this is what it provides to the residents,” he said.