As Covenant Care shakes up its leadership team from top to bottom, its new CEO Nathan Ure is honing in on the skilled nursing operator’s clinical acumen.
Taking a page from what is being done both in the state of California and what’s being requested by the Centers for Medicare & Medicaid Services, Ure believes skilled nursing operators like Covenant Care should embrace value-based purchasing programs and “chase down quality.”
Such decisions have also led to noticeably increased census, he said.
“They’ve been saying yes to a lot more patients that [the clinical team] didn’t used to. So the nurses are saying, ‘I’ve got support, I’ve got somebody that has my back,’ and so our census has grown dramatically — by about 60-70% skilled mix over the last three months,” Ure told Skilled Nursing News at the 2022 NIC Fall Conference in Washington, D.C.
It’s part of the bigger idea of taking a much more proactive approach in patient care, or in Ure’s words, being fire marshals instead of firefighters.
Ure joined the Covenant Care team back in June after spending nearly eight years in executive leadership roles at Sun Mar Healthcare. Ure is joined by a new executive leadership team, including Bryce Porter as chief strategy officer and Tammy Pirhekayati as chief clinical officer.
Aliso Viejo, Calif.- based Covenant Care operates 29 skilled nursing facilities in California and Nevada.
If nursing homes can embrace higher acuity residents, and meet the quality measures set by the federal government to receive those incentives, then “nobody can touch us.”
“With such a cost effective solution to the lower lying DRGs, there’s some lower rung DRGs the hospitals don’t need to take care of — you can do it. But you need to pay us for it,” he told SNN.
The interview has been edited for length and clarity.
Tell me a little bit about where you see the future for Covenant. What are some of your short-and-medium-term goals?
CMS put out a letter a couple of weeks ago … It described the intent and essential nature that any programs need to be driven by quality, and that’s also what’s happening in California.
So even though CMS has been doing value-based purchasing and a lot of these different things, the letter, I think, solidifies the urgency to make new programs. There were several rewards for Covid that were really meaningful amounts of money, and we took advantage of those.
Covenant Care wasn’t built around chasing down the quality measures and chasing down those things, so we’re very clinically driven by data. We’re also looking at clinical projects that have an umbrella effect. So you handle something with skin, you’re going to handle nutrition and several other aspects in that process.
We had this awesome moment last week where the clinical team was really brought together for the first time in its new iteration and the lights were going on and they were really understanding how the data drives every visit of the regional nurses. Data puts purpose into the meetings. If you do this, if you execute on this plan that our clinical team has, and proven works, the quality gets there and we’ll be rewarded. So that’s been the direction that they didn’t really have in their sights.
Is there anything else that you’re excited about?
There’s also a confidence in the clinical teams with this support. They’ve been saying yes to a lot more patients that they didn’t used to. So the nurses are saying, ‘I’ve got support, I’ve got somebody that has my back,’ and so our census has grown dramatically — by about 60-70% skilled mix over the last three months.
It’s this idea of fire marshals versus firefighters. Firefighters go where conditions exist that created a fire. Fire marshals go and make sure things are set up so that you don’t have a fire.
We’ve also changed the way we’re recruiting. So it seemed like there was a bucket with a hole in the bottom of it that you would pour water into to try to get ahead of the staffing shortages. We’ve done some things to normalize wages, create a better sense of belonging. We’re only as good as our worst station on the worst shift, and so we’re really diving into where we have those holes and where is the leadership that props that up.
Aside from CNAs, are there any other positions that you are seeing to be hard to recruit, and even on the retention side, what is Covenant trying to do there?
We need to celebrate our housekeepers better. LVNs [licensed vocational nurses] are like gold. A lot of LVNs were sucked into Covid testing or other emergent areas of care at our expense.
The thing that breaks my heart is that I feel like DONs during Covid got to a point where, and then with the prolonged nursing shortages, they’ve been pushing carts for a long time and in charge of all of their responsibilities that somebody just said, ‘What reasons have we given DONs a reason to believe that it’s still OK to be a DON?’ Is there still a future of meaningful work for DONs and so we’ve really looked at that and we’re trying to adjust those issues and make sure they’re not exhausted.
On the topic of regulation, how has Covenant contended with all of the changing regulations and been proactive on those regulatory challenges like you are on the clinical side?
It kind of blows my mind because I never could have foreseen a time when they would have suspended the surveys and people are kind of out of practice. Anytime there’s something compliance coming out our team operationalizes it so quickly … We’re also just doing mock surveys … We use the same tools as a surveyor to try to ask the same questions as the surveyors in a way of discovery and playing together in this era that we’re opening up again.
Where do you see the future of behavioral health both for Covenant and the industry in general, and what importance does it play in nursing homes?
It just requires more training for your teams and it also requires everyone just to say get over it, you’re going to have a lot of mental health issues and you can’t treat people … These are the people in our community. So part of that is just the acceptance of another part is the training.
It’s gotta be more sophisticated training for our people. And then we just have to take care, a lot of security and mental health. I do foresee that there’s going to have to be more sophistication in the way we look at GDR [gradual dose reduction].
I’m also rethinking what smoking breaks look like because nicotine is honestly one of the very best anti-psychotic products possible and we used to try to be moving towards non-smoking. There’s also a lot of non-pharmacological approaches, we’ve done a lot of Aromatherapy in our facilities. So I think it’s up to every facility to figure out what works for them to offer those things and really reinforce and reward those programs.
Aside from staffing, what do you see as the biggest challenge facing providers coming down the pike?
We need to carve out and properly hold our own in the care spectrum. The acuity that’s been forced upon us, I don’t think has always been embraced, and we’ve got to lean into the higher acuity and lean into the value proposition as an extension of the hospitals.
People have got to invest in operational partners that really know what they’re doing and you can’t cut corners with the clinical team and that game plan. So now’s the time to really double down on clinical programs.
What is one trend or innovation in the industry that excites you?
I think it’s the value-based purchasing, the rewards for clinical outcomes and rewarding the higher acuity. It’s so exciting to me. It means everything that people have to chase down quality, and you have to prove it. I think the government has done enough identification of those quality measures and based on the MDS’s I think you can know people’s quality is and it’s really worth playing for.
If we’re really leaning into where we need to, nobody can touch us. With such a cost effective solution to the lower lying DRGs simple lower, there’s some lower rung DRGs the hospitals don’t need to take care of — you can do it. But you need to pay us for it.
Companies featured in this article:
Centers for Medicare & Medicaid Services, CMS, National Investment Center for Seniors Housing & Care, NIC
