This article is sponsored by PointClickCare. In this Voices interview, Skilled Nursing News sits down with PointClickCare Senior Vice President of Strategic Market Programs Terri Weckle to learn the biggest changes in the skilled world other than the Patient-Driven Payment Model (PDPM), the best ways skilled providers can grow financially healthy, and the work providers are doing to not just survive, but thrive.
Skilled Nursing News: With PDPM taking effect in October, 2019 was a massive year of change in the skilled world. How do you think SNFs did in preparing for PDPM, and how are they doing here in the early going of 2020?
Weckle: I think the industry as a whole did pretty well. We often divide providers into thirds, where a third of them are the overachievers, a third are really still very good but tend to follow a bit. The last third typically waits until the last minute.
But I think overall, providers did well in preparing. The top third is looking at their data, analyzing what worked and where opportunities still exist. Most providers are recognizing that this isn’t a “one and done,” and they are anticipating more changes to come. But overall, we are seeing folks settle into their new reality.
We’re talking a lot about PDPM, but it wasn’t the only big change in the skilled world last year. From your perspective, what were the most significant events in 2019 other than PDPM as they pertain to SNF operations in 2020?
Weckle: I think the three major ones are staffing, Medicare Advantage, and occupancy. Staffing got a lot of attention last year with the media. SNF providers have historically had issues with staffing, but with the low unemployment rate, I think it received extra focus this year.
Medicare Advantage has continued to grow, and we’re now seeing that some organizations actually have more Medicare Advantage patients than traditional Medicare, which of course brings all of the challenges that come along with being able to manage those types of patients. And of course, occupancy is still an issue in a lot of states. We continue to see the SNF being skipped and patients discharged from hospital directly home with home health services.
You’ve noted that when you ask clients how they’re getting ahead, they respond, “We’re just trying to survive.” What are you hearing in terms of how these clients are working to survive in 2020? What strategies are they taking?
Weckle: One of the things that I hear over and over again is a question around clinical, operational, and administrative efficiencies: How can we work smarter and not harder? How can we do more with less, recognizing that staffing is always going to be a challenge? We see them focused on investing in programs and technology that help to gain efficiencies, reduce operating expenses, and improve staff satisfaction.
There is also a lot of focus on customers telling their value story. In other words, why pick my nursing home? We see them comparing their clinical outcomes to those of their competitors — meaning, other SNF or home health agencies. We also see them focused on strengthening their relationships with their referral sources, by analyzing their referral discharge patterns and identifying opportunities to fill gaps for services needed in the community and taking on more risks in order to secure a strategic referral partnership.
How do you think people are doing with that so far?
Weckle: It’s still early, but there is definitely a shift. It feels like in the last 12 to 18 months, folks are embracing the concept of best practices. “Standardization” used to be a bad word. Now I think there’s a change in the industry. People are shifting away from a “do-it-yourself” attitude and recognizing the need to embrace best practices and evidence-based protocols. They are asking themselves, “What are my peers doing?” And they are seeing that when they incorporate the best practices they see from their peers, they have better, more predictable outcomes. That shift in mentality is huge, and technology is making it possible.
What are the best ways that SNFs can be precise about how they fill their beds under PDPM?
Weckle: Whether pre-PDPM or post-PDPM, it’s all about getting patients in as quickly as we can. For the most part, I don’t hear folks saying that we’re really changing how we qualify patients and who we can take yet. I think where the real opportunity is, and where I think some of the more forward-thinking providers are looking, is asking, “How do I leverage the data better to understand where my opportunities are in the marketplace?” They are trying to understand what patients they are denying, what patients they are losing and why, and if there are services that are really needed in the community that they’re not providing and should be thinking about.
I think providers want to better understand the referrals they’re getting, the referral trends with key accounts, and where opportunities exist. It’s not that they’re really changing their position on who they should say yes to or no to today. Instead, they are trying to understand, “Is there an opportunity to take a patient who I traditionally might not have taken?”
Maybe there was an issue under prior reimbursements, or maybe they didn’t market themselves to their referral sources properly, and they want to go back and revisit that. Maybe it’s upskilling in their facility, making sure that their nurses can provide certain services.
One thing that’s been very surprising to me in working with our customers is that lack of visibility to their referral data. Tracking all the referrals, not just the ones you admit, provides the needed information to make good business decisions.
You’ve talked about the challenge that SNFs face in lean years. How bad do you think it will be in 2020?
Weckle: I think the reality is that the PDPM change seems to have given folks a little bit of breathing room. Their rates are up slightly. But the reality is that it will likely be short-lived. If we’re starting to see the reimbursement rates slightly up, there probably will be some adjustment coming from CMS. We are also seeing length of stay continue to shorten, which could have a negative impact if admissions aren’t increasing in order to maintain occupancy levels.
What are the three most exciting ways in which PCC is helping clients weather the PDPM storm in 2020?
Weckle: Better visibility and accessibility of data. I’ve heard folks talk about data as the new oil: If cash is king, then data is the queen. I think we at PointClickCare are leaning in on that heavily.
We’ve made and will continue to make substantial investments to improve the way that data is captured from a clinical perspective. Our Nursing Advantage product, for example, helps clinicians capture the right information at the right time in their care delivery process.
We also continue to invest in our insight products to ensure that we’re giving that right information back to the clinician in their clinical workflow, as well as better insights to manage their entire population.
We continue to focus on care coordination — or, care incorporation. It’s the ability to make sure that we’re sharing the right information, not just within that care team in the facility, but across that entire virtual care team that includes the physicians in the payer networks, and the discharging partners. One example of that is our Carequailty partnership where we are embedding the data exchange into the workflow so that information is flowing to the right people at the right times.
What do you think are the biggest opportunities for skilled nursing providers in 2020? What are the areas where they can grow and become more financially healthy?
Weckle: I think one of the biggest opportunities for skilled providers is focusing on their front-door processes. We talk about it as mastering the pre-admission process, but the key is asking, “Who are my key referral sources? What are the needs of that referral source? And what types of patients are they looking to discharge that I’m well suited to take?”
You have to use the data to answer those questions, be able to market the services that you can provide, and prepare the facility for the admission.
The days of, “Get to ‘yes’ fast and extend the bed offer. Once I get the acceptance, I’m good until they arrive in the facility” — those days are over. That is really the starting point now. Once I get the acceptance, now the work really starts. Before the patient even arrives in the facility, you have to make sure that you understand all of the patient’s clinical needs, equipment needs, and their expectations so that you have a successful day one and beyond.
That is what will set you up to make sure that you’re not sending the patient back two days later because you didn’t have all the information, and enable you to represent the complete picture of the patient’s needs in the MDS five-day assessment to ensure you get reimbursed appropriately for the entire stay. Mastering the pre-admission process is one big way that providers can set themselves up to be financially healthy.
Editor’s note: This interview has been edited for length and clarity.
PointClickCare is the leading electronic health record (EHR) technology partner to North America’s long-term post-acute care industry. To learn more about how PointClickCare can help your business, visit them at pointclickcare.com.
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