With 6.9 million Americans living with Alzheimer’s and the rate of new diagnoses increasing as the population ages, new research from an incoming VCU Department of Health Administration faculty member shows these patients and those with related dementias are less likely to go to a preferred skilled nursing facility (SNF) after a hospital stay.

John McHugh, Ph.D., who joins the College of Health Professions as associate professor of health administration this fall, brings a robust research program that explores patient access and how hospital choices shape care continuity.

“What decisions do we have to make to excel as an organization? That doesn't always necessarily mean growth,” McHugh said. “It could mean meeting the expectations and goals that you've set for yourself and within the broader context of your market.”

In the space of “organizational decision-making,” McHugh combines organizational theory with health services research methods to better understand organizational changes and how they might affect patient outcomes. That includes a primary focus on how Medicare beneficiaries move between hospitals and post-acute providers.

“Organizational theory includes a broad range of topics including the formation, operation and structures of organizations. I like to explore the ways organizations can manage people in order to achieve shared goals,” McHugh explained.

“When I think about a patient transitioning from a hospital to a skilled nursing facility, for instance, I'm thinking about the power dynamic between the two entities,” he added. “I'm thinking about the policy environment that's driving certain decisions. I'm thinking about the competing priorities within the organization.”

As hospitals face higher volumes of patients leaving with more acute conditions in a post-pandemic environment that includes significant staffing shortages, understanding the decisions that organizations face to maintain a continuum of quality care is more important than ever. McHugh’s expertise deepens the Department of Health Administration’s research profile and curriculum.

“We have built our program’s reputation on preparing future professionals with the latest evidence-based insights and practical experiences to step into leadership roles and make effective decisions to improve patient outcomes,” said Paula H. Song, Ph.D., Richard M. Bracken Chair and Professor of Health Administration. “Dr. McHugh’s focus on organizational behavior and post-acute care research will further differentiate our department, as we give our students the knowledge they need to manage organizations through complex contemporary challenges.”

Joining a nationally known research team

McHugh comes to VCU from Columbia University’s Mailman School of Public Health, where he was faculty director of the management programs in the Department of Health Policy and Management. Within VCU Health Administration, he has access to academic scholars who are leaders in their field, thinking about health management more broadly.

“Coming to VCU afforded me an opportunity to join this growing group of experts and really push my research to the next level,” said McHugh, who started with an MBA from Duke University’s Fuqua School of Business, with a focus in health sector management. 

He leveraged that into a decade as a strategy consultant with hospitals and health systems across the country. But, still wanting an academic career, he returned to school to complete his doctoral degree from Brown University’s School of Public Health.

“It was an interesting entry point to Brown, where I received an education – but I also brought something to them,” said McHugh, whose instructional portfolio includes classes in strategic management and data analytics. “I had been running meetings and retreats with hospital leadership teams, and I had an inside look into decision-making within hospitals.”

Competing priorities: Who decides who goes where?

Turning to his research, McHugh notes that hospitals and SNFs operate under different rules, regulations and government bodies, which naturally creates potential for competing priorities. But that doesn’t matter to patients and families, who want seamless experiences and sustainable, quality care. 

Those competing priorities often start within the hospital, where decisions are made of where to transition patients every day. Not all will go to SNFs; others will go to home — with or without home health care — and still others might go to inpatient rehabilitation. 

“There are economic issues. There are social issues. There are internal politics — all of those things must be factored in,” McHugh said.

For example, in advance of reviewing transition practices in eight markets, he expected hospitals to have tighter relationships with their skilled-nursing partners, because the Affordable Care Act penalizes them if patients are readmitted after transfer. Closer relationships often means more influence, he said, but the pivotal point was how hospitals defined patient choice. 

Risk-averse organizations might determine they can’t tell their patients anything about potential facilities where they might transition for additional care. On the other side, hospitals might have a team speak to the patient to determine the best subset of facilities.

“At the end of the day, patients are still making the choice - and they can use any other facility as well. But if it matters to you, as the patient, that there is continuous, coordinated care, then you are probably going to choose one of those in the subset,” he said.

Latest research focus

The idea of decision-making and patient choice further refines his current research: “How are these organizations making decisions that affect patient outcomes — and what does that mean?” 

Many people view the hospital as holding the power in placing a patient, but McHugh and his colleagues flipped that position to consider how and when a SNF says no — especially to a patient who might need more complex care. Facilities who hire former nurses into admissions roles are those likely to turn away that case, but they had built good relationships and knew they could rely on steady referrals.

Those where admissions decisions were handled by non-clinical teams and influenced by marketing demands were more likely to say yes.

“They know they have to fill beds, and they’ll take anyone who comes in. They’re trying to get volume, whereas the other one knows they have a predictable stream,” said McHugh, returning to his recent research that shows Alzheimer’s patients don’t likely go to a preferred facility. “And so, there is something going on where certain patients are not getting full access to the full network of options.”

Ultimately, his research aims to ensure the right choices are made both within organizations and their health-care partners to ensure the best care for patients. During business school, many of his colleagues entered  the pharmaceutical and medical device industries, leaving a gap with the hospital industry. 

“I saw that as an opportunity to really have an impact in an area that was in need,” he added. “The hospital industry has a primary seat in the overall health-care picture.”