Coordinating the ecosystem: Navigating the post-acute patient journey

The Post-Acute POV

In the latest episode of the Post-Acute POV podcast, host Jim Berklan, Executive Editor of McKnight’s Long-Term Care News, introduces a dynamic panel discussion led by Chris Pugliese, Head of Interoperability at ResMed. Joining the conversation are Chris Lukezic, RN, Director of Clinical Informatics at Saber Healthcare Group, along with Tanna Wright, Intake Supervisor, and Danya Fahlstrom, Revenue Cycle Manager, both from Northwest Respiratory Services.

Together, they dive into the real-world challenges faced by skilled nursing and HME providers during transitions of care. From communication breakdowns to their direct impact on patient outcomes, the panel explores what it takes to bridge the gaps and build stronger collaboration across the continuum.

Tune in for practical insights and first-hand experiences from the front lines of post-acute care.

Topics discussed during today’s episode: 

1. [00:30 – 02:37]: Host Jim Berklan sets the stage by introducing four experts from the intersecting worlds of HME and skilled nursing. He previews a candid conversation about the complex relationships and common challenges these providers face when collaborating across care settings.
2. [02:37 – 10:15]: Chris Pugliese kicks things off with a deep dive into interoperability challenges in post-acute care. He explores how better coordination and data-sharing can unlock opportunities for more connected and effective care.
3. [10:15 – 13:50]: Chris Pugliese continues the conversation, pointing out the pitfalls of outdated analog processes in healthcare. He advocates for digital transformation as a key to improving both operational efficiency and patient outcomes.
4. [13:50 – 18:51]: Tanna Wright and Danya Fahlstrom share behind-the-scenes perspectives from their roles in intake and revenue cycle management. They highlight how their day-to-day operations impact the broader continuum of care.
5. [18:51 – 24:02]: The panel addresses the logistical hurdles DME providers face—especially around deliveries and documentation. They discuss how working across different states, technologies, and facility requirements can complicate even the most routine processes.
6. [24:02 – 29:00]: Chris Lukezic underscores the critical role of electronic signatures and timely communication in preventing care delays. His insights stress the need for proactive coordination to ensure patients receive essential supplies without disruption.
7. [29:00 – 33:24]: Chris Pugliese and Danya dig into the nuances of documentation and billing, calling for more standardized practices. They also highlight the importance of staff training and the ongoing challenge of navigating inconsistent requirements across facilities.
8. [33:24 – 38:22]: In the closing segment, the group reflects on the value of strong, collaborative relationships among clinicians, facilities, and HMEs. They emphasize how technology can help bridge gaps and streamline workflows before wrapping up with closing thoughts and gratitude for the conversation.

Resources 

• Learn more about MatrixCare at: https://www.matrixcare.com/ 
• Find out more about Northwest Respiratory Services: https://www.nwrespiratory.com/
• Find details on Saber Health: https://www.saberhealth.com/
• Listen to more episodes of the Post-Acute POV  

Disclaimer 

The content in this presentation or materials is for informational purposes only and is provided “as-is.” Information and views expressed herein, may change without notice. We encourage you to seek as appropriate, regulatory and legal advice on any of the matters covered in this presentation or materials. 

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