Customer service, staff wellbeing, and tackling low reimbursement rates are some of the top priorities for nursing home operators as they prepare for the future.
And educating and supporting care teams is especially important in order to strategize with the quality measures that will be implemented in the coming years, as these will have an undeniable impact on reimbursement.
For Austin Steele, chief strategy officer at Journey Skilled Nursing, leaders really need to look at care team members and listen to what might really engage them in their work, and create conditions that help them stay in their jobs at nursing homes.
“We’re really trying to look at what are some of the benefits that we can give them, those ancillary benefits that might really engage them to want to be here,” Steele told Skilled Nursing News. “As we look at the workforce shortage, we’re really trying to look at creative ways that we can show our team members what they mean to us.”
Steele spoke at SNN’s RETHINK conference in Chicago, along with Melissa Powell, president at the Allure Group, and Nancy Koha, chief process officer for Principle LTC.
Koha agreed that workforce stabilization and growth is important to Principle as well, with an added focus on optimizing operational efficiencies. In terms of strategies used to plan ahead, Koha said it’s so important to ensure an alignment to overall goals of the company, especially since there are so many things operations need to focus on.
“Whenever I think of alignment, I think of P.J. Fleck. He was a former coach of the Minnesota Golden Gophers, and he had the analogy of rowing a boat. In order to row a boat, you had to be in alignment,” said Koha. “Everyone had to row at the same speed with the same efficiency, all while they’re back is to the future or the goals that they’re trying to achieve, and the only thing they can see is the past, something you can’t change, but you can learn from.”
Nimble and innovative moving ahead
Challenging past practices could be a valuable strategy as operators look toward the future as well, she said, with certain things being done in the past not yielding the same results. Tweaking approaches to clinical skills development, for one, and engaging in stakeholders to make a more user-friendly experience are good places to start challenging the status quo, Koha said.
Steele echoed Koha’s thoughts on challenging past practices, with its first building acquired back in March having “pen and paper payroll,” and needing to be ushered into more digital processes.
“We are so resistant to change, not embracing a lot of the technology that is out there because we have a process that we think is working,” Steele said of the majority of skilled nursing operators. “It might be working, but we might be able to do it more efficiently or better by embracing some technology.”
But it can be hard to plan for the future when it’s so uncertain, they said, referencing the federal staffing mandate.
Journey accounts for the mandate in everything they do, from portfolio acquisitions to staffing meetings. As a growing company, the team is hyper aware of how the mandate will affect costs moving ahead.
For Principle, planning for an uncertain future means year-round advocacy. Meanwhile, Allure uses data to better inform strategy for the future.
All leaders agreed that a market analysis helps plan for the future, especially for providers looking to scale their operations. This approach also allows providers to really understand regulations specific to each state, which is indispensable regardless of growth plans, they said.
Evolving to meet a value-based reimbursement future
Powell said nursing homes have always evolved to meet payment models, learning the ins and outs and quickly adapting to stay afloat, and make money with available payment models.
Low reimbursement rates and growth of Medicare Advantage has placed undue challenges on providers. Scaling up to negotiate better rates is certainly one way to improve payment. However, providers will also need to contend with the realities of the day by improving their financial planning and resource allocation, and taking advantage of pay-for-performance incentives..
It remains to be seen how the rate gap among MA plans will stack up against rising Medicaid rates in some states, Steele said, although it still won’t likely beenough to cover current costs in the industry.
“Medicare Advantage is growing more and more … they’re going to come in, they’re going to basically tell us what they’re going to pay us. We’re going to try to negotiate but it’s one sided negotiation often,” he said. “You have to account for that.”
That’s where scale can help, he said, working with a larger partner and getting multiple managed care plans available for your residents.
In the face of evolving payment models influencing financial planning and resource allocation, Koha said it’s helpful to really understand what an operator’s risk tolerance is when looking at all available value-based care options.
“I can’t just talk about what is my overall financial risk without bringing in quality, because maybe I’m going to take a little off the top, but now with quality initiatives and value-based care, I can make up that rate, plus more if I have a risk tolerance,” she said.
Challenging what that risk tolerance looks like is something Principle is doing right now in talking to companies that specialize in managing value-based alternative payments, and looking at care partners to help improve quality outcomes.
These partners either participate in or facilitate their own value-based care program or Accountable Care Organization (ACO), she said.
“It made us look at who we used to define as competitors and say, they might need to be a partner [in value-based care],” said Koha. “We really are extremely reflective as we position ourselves for 2025.”
Companies featured in this article:
Allure Group, Allure Healthcare Services, Journey Skilled Nursing, Principle LTC
