by dmccarron | Mar 29, 2015 | Knowledge Notes
A recent article in Newsweek entitled “You Don’t Want to Be Old in These States” amplifies a longstanding dilemma confronting long-term care providers in rural settings across America. The Medicaid program is broken – where inadequate funding is a breeding ground for unfortunate incidents like this. The negativity fueled by such circumstances should be a call to action rather than a blemish on the industry and its majority of compassionate providers of care to our Medicaid dependent elderly.
The emerging landscape of the collective Senior Living Industry is leaving the chronic care resident behind – particularly the resident dependent upon Medicaid funding. The industry remains highly fragmented where providers remain payer driven – more focused on payer sources to subsidize if not abandon the losing proposition of Medicaid funding. It’s time for the industry to come together to leverage the proven “low-cost” alternative of the nursing home setting – and drive legislative change rather than being policed in a reactive fashion by escalating regulations.
All constituents to the industry have ownership in the circumstances we confront. As we migrate away from fee for service to more outcomes oriented payment systems, antiquated government payer programs focused on cost reductions require reengineering to foster more integration and alignment of all providers.
It is essential that payment reform reaches across the “continuum of care” – providing reasonable incentive for all providers in the most cost effective and efficient care setting. Perhaps a solution could stem from thoughtful integration and redistribution of public funding – aligning interests rather than fueling a divide. It is no surprise that the aging inventory of nursing homes in rural America where there is inadequate public funding to support reasonable costs of care or for reinvestment in property interests is breeding “horror stories” like this. They will remain unavoidable until we catch up with the times.
by dmccarron | Mar 11, 2015 | Knowledge Notes
Health Care Reform has essentially mandated that the Health Services realm imagine a New Future for Aging. This requires cooperation with the full complement of sub-acute care providers coupled with a renewed focus on technology gains and partnership with multiple stakeholders. Strategic Business planning that is responsive to emerging trends and dynamic changes in this sector must be equally informed by broader social and economic influences. Absent clear markers of Leadership and Vision, the advisable direction for current Operators is an exit strategy or plans for succession.
With all of the complexities emerging from healthcare reform, it is clear that the prevalence of “silos” threaten our survival. Now more than ever before, health care providers must conceive and execute strategic business plans to safeguard their asset interests and promote sustainability of continuing operations. This is particularly relevant to the Senior Housing & Care Industry – and most notably to freestanding operators of Skilled Nursing Facilities. The stable of inter-related issues and opportunities that confront us are financial, legislative, clinical, architectural, social and environmental. We would clearly advantage from an integrative perspective that acknowledges Aging as a universal process where preventative and human-centered measures apply equally across all age cohorts and business specialties.
The Skilled Nursing Sector is being dramatically redefined – where the traditional model of long-term chronic care is antiquated and trending to extinction. The new model is defined as the sub-acute provider – represented by progressive operating, clinical and rehabilitative service capabilities that are fully aligned and integrated into the “continuum of care” – strategically positioned and qualified to partner with acute care providers in particular. The greatest opportunity represented by the Skilled Nursing provider is a proven history of being the most cost effective post-acute care setting. The greatest threat is meeting and sustaining the qualifications to seize this opportunity.
Progressive operating capabilities and demonstrated care outcomes are essential. The key drivers for meeting the challenges of this new landscape will be strategic initiatives that promote active collaboration; foster provider integration; and leverage technology to evidence best practices and demonstrated outcomes. Strategic business thinking must extend to product, program and practice delivery – fully integrated and optimally aligned in the healthcare provider community. The status quo is clearly not viable – and undoubtedly operators not responsive to change will be casualties. Providers absent the willingness and resource capacity to conceive and implement Strategic Business Planning should take the next exit.
by dmccarron | Mar 3, 2015 | Knowledge Notes
The Kaiser Foundation published an issue brief in May that presents an analysis of the February 2015 update of the Nursing Home Compare database: Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State.
The brief extends to identifying correlations between nursing homes and reported ratings – factoring not-for-profit vs. for profit status; number of licensed nursing home beds; and state locations. The brief effectively amplifies the complexities and select shortcomings of the Five Star Rating System – as well as the inference that there remains a high degree of subjectivity in the system. However, the analysis excludes two fundamental criteria that undoubtedly breed material variability in ratings. Namely, the attributes of financial performance and property features that are essential considerations in proving correlations among providers.
A conclusive correlation between not-for-profit and for-profit providers cannot be made absent a financial analysis of differentiations. This extends to elements of financial performance as well as capital structure. Factors associated with revenue realization, expense management, profitability and capital resources are highly variable and influential to the rating criteria. Financial metrics introduced in a transparent and uniform manner would prove insightful in validating or otherwise interpreting correlations.
As to property features, similar variability exists among providers beyond bed size alone. Chief among these are the age, condition and functional design of the operating environment. Operating efficiencies, and by extension financial performance, drive outcomes and prove influential as to impacting rating criteria. These are important disparities to consider. Prevailing initiatives to reposition, revitalize or re-invent new models of nursing home care are clearly responsive to the predominately aged inventory of nursing homes. This trend amplifies growing recognition that the traditional “geriatric” nursing home model is not sustainable – while new models the likes of The Green House Project and Small Homes emerge. These new models are clearly conceived to support and promote resident and staff satisfaction above all. This in turn advances all facets of performance outcomes – the fundamental drivers for any rating system.
As we consider the three domains of the existing Five Star Rating System (Staffing Measures; State Health Inspections; and Quality Measures), advancing efforts to develop a more reliable and equitable process – and to draw valid correlations from reported ratings – the playing field needs to be leveled. Truly reliable ratings are predicated on differentiating between the drivers of the measurement criteria – financial and operational factors alike.
